Alessio-Mazzola Mattia, Repetto Ilaria, Russo Antonio, Clemente Antonio, Ventura Niccolò, Formica Matteo, Burastero Giorgio, Felli Lamberto
Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Viale Benedetto XV, 6, 2° piano, 16132 Genoa, Italy.
Orthopedic Clinic, Ospedale Policlinico San Martino, Genoa, Italy.
HSS J. 2020 Oct;16(3):272-279. doi: 10.1007/s11420-020-09755-7. Epub 2020 Apr 8.
Peri-prosthetic shoulder infection (PSI), a highly disabling complication of shoulder arthroplasty, often requires additional surgery and prolonged antibiotic therapy. Of strategies proposed to manage this devastating condition, the use of cement spacers, perhaps even as a definitive treatment, is debated.
QUESTIONS/PURPOSES: We sought to systematically review the literature on antibiotic-loaded cement spacers as a viable, perhaps definitive, treatment for PSI, evaluating the eradication rates, mechanical reliability, and functional results related to its use.
We conducted a systematic review of studies published from January 1, 1980, through September 1, 2019. Following the and Preferred Reporting Items for Systematic Review and Meta-analysis, we searched for studies reporting functional and clinical outcomes in patients with PSI treated with a permanent spacer of the shoulder. Two independent reviewers searched eight databases, as well as reference lists of the retrieved articles.
After exclusion criteria were applied, 12 studies were included, involving a total of 143 patients. The mean age was 65.8 years; the mean follow-up was 37.4 months. A total of 133 patients (93%) were free from infection at latest follow-up. The mean post-operative active elevation of the shoulder ranged from 48.6 to 90°, the mean abduction ranged from 51 to 75°, and external rotation ranged from 3.6 to 29°. The mean Constant-Murley score ranged from 20.6 to 42 points (out of 100, from worst to best).
The use of a permanent cement spacer is a reliable solution to PSI in low-demand, older patients with comorbidities, a population in whom it is desirable to avoid additional surgery. Our review found a high rate of infection eradication and moderate-to-good objective and subjective results. However, the overall level of evidence of included studies was very low, and higher-quality studies are needed to clarify the role of permanent spacers in the treatment of PSI.
人工肩关节周围感染（PSI）是肩关节置换术一种严重致残的并发症，常需再次手术及延长抗生素治疗时间。在为应对这一灾难性状况而提出的策略中，使用骨水泥间隔物（甚至可能作为一种确定性治疗方法）存在争议。
问题/目的：我们试图系统回顾关于载抗生素骨水泥间隔物作为PSI一种可行的、甚至可能是确定性治疗方法的文献，评估与其使用相关的根除率、机械可靠性及功能结果。
我们对1980年1月1日至2019年9月1日发表的研究进行了系统回顾。按照系统评价和Meta分析的 及优先报告项目，我们搜索了报告使用肩关节永久性间隔物治疗的PSI患者功能和临床结果的研究。两名独立评审员搜索了八个数据库以及检索到文章的参考文献列表。
应用排除标准后，纳入12项研究，共涉及143例患者。平均年龄为65.8岁；平均随访时间为37.4个月。在最近一次随访时，共有133例患者（93%）无感染。术后肩关节平均主动抬高范围为48.6至90°，平均外展范围为51至75°，外旋范围为3.6至29°。Constant-Murley平均评分范围为20.6至42分（满分100分，从最差到最佳）。
对于需求较低、患有合并症的老年患者，使用永久性骨水泥间隔物是解决PSI的可靠方法，这类人群希望避免再次手术。我们的综述发现感染根除率较高，客观和主观结果为中度至良好。然而，纳入研究的总体证据水平非常低，需要更高质量的研究来阐明永久性间隔物在PSI治疗中的作用。
