Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.
Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.
J Shoulder Elbow Surg. 2021 Mar;30(3):695-705. doi: 10.1016/j.jse.2020.09.044. Epub 2020 Nov 4.
Proximal humeral fractures are difficult injuries to treat and obtain satisfactory outcomes. For those treated with arthroplasty, humeral fracture stems have been popular due to better ability for reduction and fixation of tuberosities. This study aims to investigate the outcomes of fracture stems in shoulder arthroplasty for proximal humeral fracture and the comparison of outcomes between fracture vs. nonfracture stems.
A meta-analysis was conducted with a multidatabase search (PubMed, OVID, EMBASE, Medline) according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines on May 19, 2020. Data from all published literature meeting inclusion criteria were extracted and analyzed.
Eleven studies were included for analysis, including 383 hemiarthroplasties (HA) (294 fracture stems, 89 nonfracture stems) and 358 reverse total shoulder arthroplasties (RTSA) (309 fracture stems, 49 nonfracture stems). At the final follow-up, meta-analysis shows favorable overall ASES score in all fracture stem prosthesis (mean = 74.0, 95% confidence interval [CI]: 69.3-78.7), Constant-Murley score (mean = 67.2, 95% CI: 61.6-72.8), external rotation (mean difference [MD] = 7°, 95% CI: 3°-10°, P < .001), and forward flexion (MD = 17°, 95% CI: 10°-25°, P < .001). Pooled proportion (PP) of greater tuberosity healing (PP = 0.786, 95% CI: 0.686-0.886) was high, whereas all-cause revisions (PP = 0.034, 95% CI: 0.018-0.061) remained low. With the exception of RTSA scapular notching (PP = 0.109, 95% CI: 0.020-0.343), other complication metrics had PP of ≤0.023. In the 4 studies comparing fracture (138 HA, 54 RTSA) vs. nonfracture stems (89 HA, 49 RTSA), fracture stems had statistically significant better American Shoulder and Elbow Surgeons scores (MD = 14.29, 95% CI: 8.18-20.41, P < .001), external rotation (MD = 6°, 95% CI: 2°-9°, P = .003), forward flexion (MD = 16°, 95% CI: 7°-24°, P < .001), and greater tuberosity healing (odds ratio = 2.20, 95% CI: 1.28-3.77, P = .004). There was no statistically significant difference in complications.
Fracture stems showed promising overall clinical outcomes with low complication rates in treating proximal humeral fractures. The use of fracture stems is also associated with greater chance of tuberosity healing compared with nonfracture stems. There is increasing evidence to suggest the superiority of fracture stems over nonfracture stems in clinical outcomes, while maintaining similar complication rates.
肱骨近端骨折是一种难以治疗的骨折，治疗效果难以令人满意。对于接受关节置换术治疗的患者，肱骨骨折柄由于具有更好的复位和固定结节的能力而广受欢迎。本研究旨在探讨肱骨近端骨折关节置换术中骨折柄的疗效，并比较骨折柄与非骨折柄的疗效。
根据系统评价和荟萃分析的首选报告项目指南，于 2020 年 5 月 19 日在多数据库（PubMed、OVID、EMBASE、Medline）中进行了荟萃分析。提取并分析了所有符合纳入标准的文献数据。
共纳入 11 项研究进行分析，包括 383 例半关节成形术（HA）（294 例骨折柄，89 例非骨折柄）和 358 例反向全肩关节置换术（RTSA）（309 例骨折柄，49 例非骨折柄）。在最终随访时，荟萃分析显示所有骨折柄假体的总体 ASES 评分均较好（平均=74.0，95%置信区间[CI]：69.3-78.7）、Constant-Murley 评分（平均=67.2，95%CI：61.6-72.8）、外旋（平均差值[MD]=7°，95%CI：3°-10°，P<0.001）和前屈（MD=17°，95%CI：10°-25°，P<0.001）。较大结节愈合的高比例（PP=0.786，95%CI：0.686-0.886），而全因翻修（PP=0.034，95%CI：0.018-0.061）仍然较低。除了 RTSA 肩胛切迹（PP=0.109，95%CI：0.020-0.343）外，其他并发症指标的 PP 值均≤0.023。在 4 项比较骨折（138HA，54RTSA）和非骨折柄（89HA，49RTSA）的研究中，骨折柄的美国肩肘外科医生评分（MD=14.29，95%CI：8.18-20.41，P<0.001）、外旋（MD=6°，95%CI：2°-9°，P=0.003）、前屈（MD=16°，95%CI：7°-24°，P<0.001）和较大结节愈合（优势比=2.20，95%CI：1.28-3.77，P=0.004）均有统计学意义。并发症无统计学差异。
骨折柄在治疗肱骨近端骨折方面具有良好的临床疗效和较低的并发症发生率。与非骨折柄相比，使用骨折柄也更有可能使结节愈合。越来越多的证据表明，骨折柄在临床疗效方面优于非骨折柄，同时保持相似的并发症发生率。
