Sports Surgery Clinic, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.
Sports Surgery Clinic, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland; New York University Langone, New York, NY, United States of America.
Injury. 2022 Feb;53(2):244-249. doi: 10.1016/j.injury.2021.12.022. Epub 2021 Dec 15.
The purpose of this study is to systematically review the randomized controlled trials on the various treatment options that can be utilized in the management of displaced proximal humerus fractures.
MATERIALS & METHODS: Based on the PRISMA guidelines, three independent reviewers performed a systematic review of the literature. Randomized control trials (RCTs) focusing on the outcomes of the following interventions in the management of PHFs were considered for inclusion; (1) non-operative or conservative (NOC) management, (2) open reduction and internal fixation (ORIF), (3) intra-medullary nailing (IMN), (4) shoulder hemi-arthroplasty (HA), and (5) reverse shoulder arthroplasty (RSA). Network meta-analyses were performed using R and studies were ranked according to their P-score.
Our study included 13 RCTs. RSA had improvements in abduction, constant score, flexion, as well as lowest rates of malunion and osteonecrosis when compared to other management modalities (P-Score = 0.9786, P-Score = 0.9998, P-Score = 0.9909, P-Score = 0.9590 and P-Score = 0.8042 respectively). HA was found to have improvements in health-related quality of life scores when compared to other management modalities (P-Score = 0.9672). ORIF had the highest improvement in quick disability of arm, shoulder and hand scores and visual analogue scale scores (P-Score = 0.8209 and P-Score = 0.7155 respectively). NOC was found to have the lowest rate of conversion to surgical intervention, with RSA having the lowest rate of surgical interventions (P-Score = 0.9186 and P-Score = 0.7497 respectively).
DISCUSSION & CONCLUSION: RSA offers satisfactory improvements in clinical and functional outcomes when compared to other non-operative and operative treatment options in the management of carefully selected proximal humerus fractures, with a minimal revision rate when compared to other surgical management modalities.
I - Systematic Review & Meta-Analysis of Randomized Control Trials.
本研究旨在系统综述各种治疗选择在治疗移位性肱骨近端骨折中的应用，为临床治疗提供参考。
根据 PRISMA 指南，3 名独立审查员对文献进行了系统综述。纳入研究的主要内容为：（1）非手术或保守治疗（NOC）；（2）切开复位内固定（ORIF）；（3）髓内钉固定（IMN）；（4）人工肱骨头置换术（HA）；（5）反式肩关节置换术（RSA）。采用 R 软件进行网络荟萃分析，并根据 P 评分对研究进行排名。
本研究共纳入 13 项 RCT 研究。与其他治疗方法相比，RSA 在肩关节外展、Constant 评分、肩关节活动度、畸形愈合和骨坏死发生率等方面具有明显优势（P 评分=0.9786、P 评分=0.9998、P 评分=0.9909、P 评分=0.9590、P 评分=0.8042）；HA 在健康相关生活质量评分方面具有优势（P 评分=0.9672）；ORIF 在简易上肢功能测试（QuickDASH）评分和视觉模拟评分（VAS）方面具有明显优势（P 评分=0.8209、P 评分=0.7155）；NOC 的手术转化率最低，RSA 的手术干预率最低（P 评分=0.9186、P 评分=0.7497）。
与非手术和手术治疗方法相比，RSA 可显著改善移位性肱骨近端骨折患者的临床和功能结果，且具有较低的翻修率。
I - 系统评价和随机对照试验的荟萃分析。
