Royal Devon and Exeter Foundation Trust, Exeter, UK.
Health Services and Policy Research Unit, University of Exeter Medical School, Exeter, UK.
Bone Joint J. 2022 May;104-B(5):559-566. doi: 10.1302/0301-620X.104B5.BJJ-2021-1207.R2.
Arthroplasty is being increasingly used for the management of distal humeral fractures (DHFs) in elderly patients. Arthroplasty options include total elbow arthroplasty (TEA) and hemiarthroplasty (HA); both have unique complications and there is not yet a consensus on which implant is superior. This systematic review asked: in patients aged over 65 years with unreconstructable DHFs, what differences are there in outcomes, as measured by patient-reported outcome measures (PROMs), range of motion (ROM), and complications, between distal humeral HA and TEA?
A systematic review of the literature was performed via a search of MEDLINE and Embase. Two reviewers extracted data on PROMs, ROM, and complications. PROMs and ROM results were reported descriptively and a meta-analysis of complications was conducted. Quality of methodology was assessed using Wylde's non-summative four-point system. The study was registered with PROSPERO (CRD42021228329).
A total of 29 studies met the inclusion and exclusion criteria. The mean Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) score was 19.6 (SD 7.5) for HA and 38 (SD 11.9) for TEA and the mean abbreviated version of DASH was 17.2 (SD 13.2) for HA and 24.9 (SD 4.8) for TEA. The Mayo Elbow Performance Score was the most commonly reported PROM across included studies, with a mean of 87 (SD 5.3) in HA and 88.3 (SD 5) in TEA. High complication rates were seen in both HA (22% (95% confidence interval (CI) 5 to 44)) and TEA (21% (95% CI 13 to 30), but no statistically significant difference identified.
This systematic review has indicated PROMs and ROM mostly favouring HA, but with a similarly high complication rate in the two procedures. However, due to the small sample size and heterogeneity between studies, strength of evidence for these findings is low. We propose further research in the form of a national randomized controlled trial. Cite this article: 2022;104-B(5):559-566.
关节成形术越来越多地用于治疗老年患者的肱骨远端骨折（DHFs）。关节成形术的选择包括全肘关节成形术（TEA）和半关节成形术（HA）；两者都有独特的并发症，目前还没有关于哪种植入物更优越的共识。本系统评价提出的问题是：在年龄超过 65 岁且不可重建的 DHFs 患者中，在患者报告的结果测量（PROMs）、活动范围（ROM）和并发症方面，肱骨远端 HA 和 TEA 之间有何差异？
通过对 MEDLINE 和 Embase 的搜索，进行了文献的系统评价。两名审查员提取了关于 PROMs、ROM 和并发症的数据。PROMs 和 ROM 结果以描述性方式报告，并对并发症进行了荟萃分析。使用 Wylde 的非总结性四点系统评估方法的质量。该研究在 PROSPERO（CRD42021228329）上进行了注册。
共有 29 项研究符合纳入和排除标准。HA 的平均 Disabilities of the Arm, Shoulder and Hand questionnaire（DASH）评分（标准差 7.5）为 19.6，TEA 为 38（标准差 11.9），HA 的简化版 DASH 平均评分为 17.2（标准差 13.2），TEA 为 24.9（标准差 4.8）。Mayo 肘关节表现评分是纳入研究中最常用的 PROM，HA 为 87（标准差 5.3），TEA 为 88.3（标准差 5）。HA（22%（95%置信区间（CI）5 至 44））和 TEA（21%（95% CI 13 至 30））的并发症发生率都很高，但没有发现统计学上的显著差异。
本系统评价表明，PROMs 和 ROM 主要倾向于 HA，但两种手术的并发症发生率也很高。然而，由于研究之间的样本量小且存在异质性，这些发现的证据强度较低。我们建议进一步开展以全国随机对照试验形式的研究。引用本文：2022；104-B（5）：559-566。
