Virginia Commonwealth University Health, 1250 E. Marshall St., Richmond, VA, 23219, USA.
Eur J Orthop Surg Traumatol. 2023 Jul;33(5):2063-2068. doi: 10.1007/s00590-022-03400-1. Epub 2022 Oct 2.
Reverse total shoulder arthroplasty is an established treatment method for comminuted proximal humerus fractures. Both cemented and uncemented techniques exist, with uncemented reverse total shoulder offering many theoretical advantages, including improved biologic fixation, absence of cement related complications, and ease of revision if necessary. There are few studies comparing the outcomes of the two techniques.
The study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A search for studies assessing clinical outcomes of reverse total shoulder arthroplasty for proximal humerus fractures was performed of PubMed, Embase, Web of Science, and Cochrane Library. Main outcomes included Constant Score (CS), American Shoulder and Elbow Surgeons (ASES) score, and complication rate. Inclusion criteria were as follows: indication for arthroplasty was fracture; minimum one year follow up; article in English. Exclusion criteria were as follows: review articles; biomechanical or cadaver studies. Quality analysis was performed using the Cochrane Risk of Bias tool (RoB 2) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool.
A total of 682 studies were identified through the initial search, with 36 studies meeting all inclusion criteria. There were 24 studies investigating cemented technique, 10 studies examining uncemented technique, and two studies involving both techniques. There was no difference in mean follow up between patients receiving a cemented vs. uncemented rTSA (32.3 months vs. 30.6 months, p = 0.06). Patients who received a cemented rTSA had a significantly higher Constant-Murley score than those who received an uncemented rTSA (59.4 vs 55.9, p < .001). There was no difference between the two groups when comparing ASES Scores (77.5 vs 78.6, p = 0.54) and overall complication rates (11.1% vs 11.8%, p = 0.23).
Both cemented and uncemented rTSA are both valid options for treating acute proximal humerus fractures. Cemented rTSA may portend slightly improved clinical outcomes with similar overall complication rates compared to uncemented rTSA for proximal humerus fractures.
反式全肩关节置换术是治疗粉碎性肱骨近端骨折的一种成熟方法。既有骨水泥固定技术，也有无骨水泥固定技术，无骨水泥反式全肩关节置换术具有许多理论优势，包括改善生物固定、避免骨水泥相关并发症，以及必要时易于翻修。比较两种技术结果的研究较少。
本研究按照系统评价和荟萃分析的首选报告项目（PRISMA）声明进行。对 PubMed、Embase、Web of Science 和 Cochrane 图书馆中评估反式全肩关节置换术治疗肱骨近端骨折临床结果的研究进行了检索。主要结果包括 Constant 评分（CS）、美国肩肘外科医生（ASES）评分和并发症发生率。纳入标准如下：关节置换适应证为骨折；至少随访 1 年；文章为英文。排除标准如下：综述文章；生物力学或尸体研究。使用 Cochrane 偏倚风险工具（RoB 2）和非随机干预研究的偏倚风险（ROBINS-I）工具对质量进行分析。
通过初步检索共确定了 682 项研究，其中 36 项研究符合所有纳入标准。有 24 项研究调查了骨水泥固定技术，10 项研究研究了非骨水泥固定技术，还有两项研究涉及这两种技术。接受骨水泥固定 rTSA 和非骨水泥固定 rTSA 的患者平均随访时间无差异（32.3 个月 vs. 30.6 个月，p=0.06）。接受骨水泥固定 rTSA 的患者 Constant-Murley 评分显著高于接受非骨水泥固定 rTSA 的患者（59.4 vs 55.9，p<.001）。两组 ASES 评分（77.5 vs 78.6，p=0.54）和总体并发症发生率（11.1% vs 11.8%，p=0.23）无差异。
骨水泥固定和非骨水泥固定 rTSA 都是治疗急性肱骨近端骨折的有效选择。与非骨水泥固定 rTSA 相比，骨水泥固定 rTSA 可能预示着略微改善的临床结果，且总体并发症发生率相似。
