From the Faculty of Medicine, McGill University; and Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre.
Plast Reconstr Surg. 2021 Dec 1;148(6):946e-958e. doi: 10.1097/PRS.0000000000008514.
Growing use of pyrocarbon implants in upper extremity arthroplasty has culminated in a breadth of literature ascertaining outcomes and complications at long-term follow-up. However, at present, the literature remains devoid of studies synthesizing the available evidence for upper extremity surgeons to adequately assess the safety and utility of these implants relative to other available options.
A systematic search of the National Library of Medicine, MEDLINE, and Embase databases was performed to determine clinical outcomes and complication and reoperation rates following pyrocarbon arthroplasties in the upper extremity. A breakdown of complication and reoperation rates for each independent joint (shoulder, elbow, wrist, and hand joints), and according to specific causes necessitating surgery, was also compiled.
A comprehensive summary of functional outcomes following upper extremity pyrocarbon arthroplasties is presented. Overall complication and reoperation rates in the hand and wrist were determined to be 28.2 percent and 17 percent, respectively. The proximal interphalangeal joint was associated with the highest complication rate (42.7 percent), followed by carpometacarpal joint (18.8 percent), metacarpophalangeal joint (17.6 percent), wrist (16 percent), elbow (15.7 percent), and shoulder (12.9 percent). In the hand and wrist, major complications included dislocations and subluxations (8.4 percent), stiffness and limited motion (4.4 percent), deformity (3.1 percent), hardware failure (1.9 percent), fractures (1.7 percent), persistent pain (1.7 percent), and infections (0.9 percent).
In the absence of large clinical trials, systematic reviews such as these can help inform clinical guidelines and provide practitioners with an evidence-based reference to improve informed consent.
在上肢关节置换术中越来越多地使用热解碳植入物，这导致了大量文献确定了长期随访时的结果和并发症。然而，目前文献中仍然缺乏研究来综合评估这些植入物的安全性和实用性，以便上肢外科医生能够充分评估这些植入物相对于其他可用选择的安全性和实用性。
对国家医学图书馆、MEDLINE 和 Embase 数据库进行了系统检索，以确定在上肢进行热解碳关节置换术后的临床结果以及并发症和再次手术的发生率。还根据需要手术的具体原因，对每个独立关节（肩部、肘部、腕部和手部关节）的并发症和再次手术发生率进行了分类。
提供了上肢热解碳关节置换术后功能结果的综合总结。手部和腕部的总并发症和再次手术发生率分别为 28.2％和 17％。近节指间关节的并发症发生率最高（42.7％），其次是腕掌关节（18.8％）、掌指关节（17.6％）、腕关节（16％）、肘关节（15.7％）和肩关节（12.9％）。手部和腕部的主要并发症包括脱位和半脱位（8.4％）、僵硬和运动受限（4.4％）、畸形（3.1％）、内固定失败（1.9％）、骨折（1.7％）、持续性疼痛（1.7％）和感染（0.9％）。
在缺乏大型临床试验的情况下，此类系统评价可以帮助制定临床指南，并为医生提供循证参考，以改善知情同意。
