Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
J Shoulder Elbow Surg. 2022 Mar;31(3):e101-e119. doi: 10.1016/j.jse.2021.10.011. Epub 2021 Nov 2.
The purpose of this systematic review was to compare functional outcomes, complications, and revision rates between cemented and uncemented reverse shoulder arthroplasty (RSA) for proximal humeral fractures (PHFs).
A systematic search was performed in April 2021 within PubMed, Scopus Web of Science, and Cochrane Library databases for clinical studies reporting outcomes of RSA performed for PHF. Included studies were published in English, had a minimum 1-year follow-up, specified whether the humeral stem was cemented (cRSA) or uncemented (ucRSA), and were evidence level I-IV. Data including range of motion (ROM), functional status, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Constant-Murley score, visual analog scale (VAS) score, tuberosity healing, complications, and reoperations were extracted. DerSimonian-Laird random effects models with subgroup stratification analyses were applied to investigate differences in outcomes between patients with cRSA and ucRSA.
A total of 45 studies comprising 1623 patients were included. The overall pooled age was 75.9 ± 3.4 years. At a mean follow-up of 34.6 (range, 12-108) months, there were no significant differences in ROM, VAS score, Constant-Murley score, rate of tuberosity healing, or reoperation rates between the cRSA and ucRSA cohorts. The mean postoperative ASES score in the cRSA cohort (73.9, 95% CI 71.4-76.5) was significantly lower than the ucRSA cohort (82.9, 95% CI 75.9-90.0, P = .013). The incidence of postoperative all-cause complications was significantly lower in the cRSA cohort (5.5%, 95% CI 4.0%-6.9%) compared with the ucRSA cohort (9.7%, 95% CI 4.5%-14.9%, P = .044).
The use of uncemented humeral stems in RSA for PHF confers similar functional results to the use of cemented stems in terms of pain, range of motion, functional scores, and tuberosity healing. Although the rate of complications was significantly higher in the uncemented cohort compared with the cemented cohort (9.7% vs. 5.5%, respectively), the rate of reoperations was similar between the groups (1.6% vs. 1.9%, respectively). The uncemented reverse prosthesis seems to be a valid alternative for the management of patients with complex proximal humerus fractures.
本系统评价旨在比较骨水泥型和非骨水泥型反式肩关节置换术（RSA）治疗肱骨近端骨折（PHF）的功能结果、并发症和翻修率。
2021 年 4 月，在 PubMed、Scopus Web of Science 和 Cochrane Library 数据库中进行了系统检索，以查找报告 PHF 行 RSA 后结果的临床研究。纳入的研究均为英文发表，随访时间至少 1 年，明确了肱骨干是否骨水泥固定（cRSA）或非骨水泥固定（ucRSA），证据水平为 I-IV 级。提取的数据包括活动范围（ROM）、功能状态、美国肩肘外科医生协会（ASES）标准肩关节评估表评分、Constant-Murley 评分、视觉模拟评分（VAS）、结节愈合、并发症和再手术情况。应用 DerSimonian-Laird 随机效应模型和亚组分层分析，以研究 cRSA 和 ucRSA 患者之间的结局差异。
共纳入 45 项研究，包括 1623 例患者。总体平均年龄为 75.9±3.4 岁。在平均 34.6 个月（12-108 个月）的随访中，cRSA 和 ucRSA 两组间的 ROM、VAS 评分、Constant-Murley 评分、结节愈合率或再手术率均无显著差异。cRSA 组术后 ASES 评分（73.9，95%CI 71.4-76.5）显著低于 ucRSA 组（82.9，95%CI 75.9-90.0，P=0.013）。cRSA 组术后全因并发症发生率（5.5%，95%CI 4.0%-6.9%）显著低于 ucRSA 组（9.7%，95%CI 4.5%-14.9%，P=0.044）。
在 RSA 治疗 PHF 中使用非骨水泥肱骨干与使用骨水泥肱骨干相比，在疼痛、活动范围、功能评分和结节愈合方面具有相似的效果。尽管非骨水泥组的并发症发生率显著高于骨水泥组（分别为 9.7%和 5.5%），但两组的再手术率相似（分别为 1.6%和 1.9%）。非骨水泥反向假体似乎是治疗复杂肱骨近端骨折患者的有效选择。
