关节置换手术在治疗复杂肱骨近端骨折方面真的更好吗？一项全面的荟萃分析和系统评价。
Are Arthroplasty Procedures Really Better in the Treatment of Complex Proximal Humerus Fractures? A Comprehensive Meta-Analysis and Systematic Review.
作者信息
Pizzo Richard A, Gianakos Arianna L, Haring Richard Sterling, Gage Mark J, Stevens Nicole M, Liporace Frank A, Yoon Richard S
机构信息
Department of Orthopaedic Surgery, Jersey City Medical Center-RWJ Barnabas Health, Jersey City, NJ.
Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN.
出版信息
J Orthop Trauma. 2021 Mar 1;35(3):111-119. doi: 10.1097/BOT.0000000000001926.
OBJECTIVE
A meta-analysis and systematic review was performed to compare outcomes of open reduction and internal fixation (ORIF), hemiarthroplasty (HA), and reverse total shoulder arthroplasty (rTSA) for complex proximal humerus fractures. Data sources: MEDLINE, Embase, and Cochrane Library databases were screened. Search terms included reverse total shoulder arthroplasty, open reduction internal fixation, hemiarthroplasty, and proximal humerus fracture.
STUDY SELECTION
English-language studies published within the past 15 years evaluating outcomes of ORIF, rTSA, or HA for complex proximal humerus fractures with minimum of 1-year follow-up were included, resulting in 51 studies with 3064 total patients. Review articles, basic science studies, biomechanical studies, and cadaveric studies were excluded.
DATA EXTRACTION
The methodological quality of evidence was assessed using the Jadad scale and methodological index for nonrandomized studies.
DATA SYNTHESIS
Demographic data were compared using the χ2 test. Mean data were weighted by study size and used to calculate composite mean values and confidence intervals. Continuous data were compared using the Metan module with fixed effects. Count data were compared using the Kruskal-Wallis test. Alpha was set at 0.05 for all tests.
CONCLUSIONS
Patients undergoing rTSA had lower risks of complication (relative risk 0.41) and reoperation (relative risk 0.28) than HA patients. rTSA resulted in higher Constant scores (standard mean difference 0.63) and improved active forward flexion when compared with HA (standard mean difference 0.76). Pooled mean data demonstrated better outcome scores and active forward flexion of ORIF versus HA and rTSA, although the patients were younger and had more simple fracture patterns.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
目的
进行一项荟萃分析和系统评价，以比较切开复位内固定术（ORIF）、半关节成形术（HA）和反式全肩关节置换术（rTSA）治疗复杂肱骨近端骨折的疗效。
数据来源
检索了MEDLINE、Embase和Cochrane图书馆数据库。检索词包括反式全肩关节置换术、切开复位内固定术、半关节成形术和肱骨近端骨折。
研究选择
纳入过去15年内发表的、评估ORIF、rTSA或HA治疗复杂肱骨近端骨折疗效且随访至少1年的英文研究，共51项研究，总计3064例患者。排除综述文章、基础科学研究、生物力学研究和尸体研究。
数据提取
采用Jadad量表和非随机研究方法学指数评估证据的方法学质量。
数据综合
使用χ²检验比较人口统计学数据。均值数据按研究规模加权，用于计算综合均值和置信区间。连续数据使用固定效应的Meta模块进行比较。计数数据使用Kruskal-Wallis检验进行比较。所有检验的α值设定为0.05。
结论
与HA患者相比，接受rTSA治疗的患者并发症风险（相对风险0.41）和再次手术风险（相对风险0.28）更低。与HA相比，rTSA的Constant评分更高（标准均值差0.63），主动前屈改善（标准均值差0.76）。汇总的均值数据显示，尽管ORIF组患者更年轻且骨折类型更简单，但与HA和rTSA相比，其疗效评分和主动前屈更好。
证据级别
治疗性IV级。有关证据级别的完整描述，请参阅作者须知。
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