Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA.
Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA.
J Shoulder Elbow Surg. 2022 Nov;31(11):2410-2420. doi: 10.1016/j.jse.2022.05.002. Epub 2022 Jun 4.
Since the introduction of the Grammont-style reverse total shoulder arthroplasty, the humeral stem design has been modified with improved clinical outcomes. Two distinct humeral designs have been used extensively: the inlay design, in which the humeral tray is seated within the metaphysis, and the onlay design, in which the humeral tray sits on the metaphysis at the level of the humeral neck cut. The purpose of this systematic review was to determine whether there are differences in clinical outcomes and complication rates between these designs.
The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used to perform this systematic review. A search of MEDLINE, PubMed, and Embase was performed to identify all studies comparing the clinical results of both humeral designs. Primary outcomes included patient-reported outcome measures, shoulder range of motion, and incidence of complications.
From the 156 identified publications, 12 studies were included in the final review. A total of 1447 patients were included, with a minimum follow-up period of 12 months. At final follow-up, both implants demonstrated significant improvements in comparison to preoperative baseline. On comparison of the inlay vs. onlay groups, the American Shoulder and Elbow Surgeons score was higher in the inlay group (mean difference, 2.53 [95% confidence interval, 0.27-4.78]; P = .03). Postoperative motion, even if statistically greater in the onlay group (differences of 5° in forward flexion [P < .001], 3° in abduction [P = .003], and 4° in external rotation [P < .001]), was not clinically different. On comparison of complications, the inlay group showed more instances of scapular notching (93 of 322 patients vs. 70 of 415 patients; odds ratio, 0.35; P < .001) but fewer scapular spine fractures (26 of 727 patients vs. 21 of 559 patients, P = .09).
Inlay and onlay humeral tray designs in reverse total shoulder arthroplasty demonstrate similar clinical improvements postoperatively. Onlay implants have a low rate of scapular notching but a higher rate of scapular spine fracture. Understanding the strengths and weaknesses of the 2 humeral tray designs is important to provide surgeons with options to tailor surgical plans for high-risk patients.
自从引入 Grammont 式反式全肩关节置换术以来，肱骨柄设计已经得到了改进，临床效果也得到了改善。目前广泛使用两种不同的肱骨设计：嵌入式设计，其中肱骨托位于干骺端内；和覆盖式设计，其中肱骨托位于肱骨颈截骨处的干骺端表面。本系统评价的目的是确定这两种设计在临床结果和并发症发生率方面是否存在差异。
本系统评价按照 Preferred Reporting Items for Systematic Reviews and Meta-analyses（PRISMA）指南进行。对 MEDLINE、PubMed 和 Embase 进行了检索，以确定所有比较两种肱骨设计临床结果的研究。主要结果包括患者报告的结果测量、肩关节活动范围和并发症发生率。
从 156 篇已识别的文献中，有 12 项研究最终纳入了本次综述。共有 1447 名患者纳入研究，随访时间最短为 12 个月。在最终随访时，两种植入物与术前基线相比均有显著改善。在嵌入式与覆盖式组之间的比较中，美国肩肘外科医生评分在嵌入式组更高（平均差异 2.53[95%置信区间 0.27-4.78]；P=0.03）。术后运动，即使在覆盖式组中统计学上更大（前屈差异 5°[P<0.001]、外展差异 3°[P=0.003]和外旋差异 4°[P<0.001]），但临床差异并不显著。在比较并发症时，嵌入式组出现更多的肩胛切迹（322 例患者中有 93 例 vs. 415 例患者中有 70 例；优势比 0.35；P<0.001），但肩胛脊柱骨折较少（727 例患者中有 26 例 vs. 559 例患者中有 21 例，P=0.09）。
反式全肩关节置换术中嵌入式和覆盖式肱骨托设计术后均显示出相似的临床改善。覆盖式植入物的肩胛切迹发生率较低，但肩胛脊柱骨折发生率较高。了解这两种肱骨托设计的优缺点对于为外科医生提供选择以针对高风险患者制定手术计划非常重要。
