Na Sang-Soo, Kim Du-Han, Choi Byung-Chan, Cho Chul-Hyun
Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea.
Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea.
J Orthop Sci. 2023 Jul;28(4):772-777. doi: 10.1016/j.jos.2022.04.002. Epub 2022 Apr 28.
The purpose of this study was to investigate the outcomes and complications of hemiarthroplasty (HA) and total shoulder arthroplasty (TSA) in patients of osteonecrosis of humeral head (ONHH) through systematic review.
PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines were followed by utilizing the PubMed, EMBASE, Scopus, Ovid, and Cochrane Library databases. Keywords included ONHH, avascular necrosis, head replacement, hemiarthroplasty, or total shoulder arthroplasty. Methodological Index for Nonrandomized Studies (MINORS) was used for quality assessment.
Ten studies (416 shoulders) were finally eligible and mean MINORS score was 11.9 (ranges, 8-16). HA was performed in 255 shoulders (61.3%) and TSA in 161 (38.7%). Mean age of the patients at the time of surgery was 50.6 years and mean follow-up period was 73.1 months. All clinical scores with range of motion were significantly improved after surgery. Overall complication rate was 20.0% with 10.1% in HA and 17.5% in TSA (p = 0.077). Overall reoperation rate was 11.2% with 7.0% in HA and 15.0% in TSA (p = 0.046). Overall revision rate was 6.4% with 5.7% in HA and 9.2% in TSA (p = 0.349).
Both HA and TSA in patients with ONHH yielded functional improvement with pain relief, but TSA had higher reoperation rate compared to HA.
本研究旨在通过系统评价，调查肱骨头坏死（ONHH）患者行半肩关节置换术（HA）和全肩关节置换术（TSA）的疗效及并发症。
遵循PRISMA（系统评价和Meta分析的首选报告项目）指南，利用PubMed、EMBASE、Scopus、Ovid和Cochrane图书馆数据库。关键词包括ONHH、缺血性坏死、股骨头置换、半肩关节置换术或全肩关节置换术。采用非随机研究方法学指数（MINORS）进行质量评估。
最终纳入10项研究（416例肩部手术），平均MINORS评分为11.9（范围8 - 16）。其中255例肩部行HA（61.3%），161例肩部行TSA（38.7%）。患者手术时的平均年龄为50.6岁，平均随访时间为73.1个月。术后所有临床评分及活动度均显著改善。总体并发症发生率为20.0%，HA组为10.1%，TSA组为17.5%（p = 0.077）。总体再次手术率为11.2%，HA组为7.0%，TSA组为15.0%（p = 0.046）。总体翻修率为6.4%，HA组为5.7%，TSA组为9.2%（p = 0.349）。
ONHH患者行HA和TSA均可缓解疼痛并改善功能，但TSA的再次手术率高于HA。
