Heifner John J, Rivera Dones Asdrubal E, Wells A Laurie, Mercer Deana M
St George's University School of Medicine, Great River, NY, USA.
University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
JSES Rev Rep Tech. 2022 Oct 19;3(1):49-55. doi: 10.1016/j.xrrt.2022.09.008. eCollection 2023 Feb.
Patient age may play a role in the surgeon's decision between radial head arthroplasty (RHA) and open reduction internal fixation in radial head fracture treatment. Though large sample reports have detailed outcomes of radial head replacement for a mean age younger than 50 years, the age ranges are widely distributed Patient outcomes are not uniform across a broad age distribution. Therefore, treatment decisions should be evaluated within the confines of a narrower age bracket. An understanding of clinical outcomes for radial head replacement in younger adults will provide value for guiding treatment decisions. We performed a systematic review comparing the clinical outcomes for radial head replacement in patients younger and older than 50 years of age. Further analysis compared outcomes between RHA performed as a primary procedure and as a secondary procedure in patients younger and older than 50 years of age.
PubMed was queried for articles which delineated individual patient data for age, surgical treatment, and appropriate outcome metrics. Articles were grouped based on patient age of under 50 and over 50 years and within those age groups, based on the arthroplasty being performed as a primary or as a secondary procedure.
There were no significant differences between the under 50 and the over 50 groups for Mayo Elbow Performance Score ( = .79) and for implant revision/removal ( = .32). In the under 50 group, RHA done as a primary procedure had significantly higher ( = .001) mean Mayo Elbow Performance Score than RHA done as a secondary procedure. In the over 50 group, relative risk was 2.39 (95% confidence interval, 2.12-2.69) for implant revision/removal ( = .11) when comparing primary and secondary procedures.
At a mean follow-up of 48 months, RHA in patients under the age of 50 years had satisfactory outcomes which were comparable to outcomes in patients over the age of 50 years. Across both age groups, arthroplasty performed as a primary procedure demonstrated superior outcomes compared to arthroplasty performed as a secondary procedure. Our findings provide guidance to surgeons who face a multifaceted decision when encountering younger adult patients with radial head fracture patterns that may not be amenable to fixation. Awareness of the age-specific performance of radial head implants is an important component of the decision for surgical treatment.
在桡骨头骨折治疗中，患者年龄可能会影响外科医生在桡骨头置换术（RHA）和切开复位内固定术之间的选择。尽管大型样本报告详细阐述了平均年龄小于50岁的桡骨头置换的结果，但年龄范围分布广泛，在广泛的年龄分布中患者的结果并不一致。因此，治疗决策应在较窄的年龄范围内进行评估。了解年轻成年人桡骨头置换的临床结果将为指导治疗决策提供价值。我们进行了一项系统评价，比较了年龄小于50岁和大于50岁的患者桡骨头置换的临床结果。进一步分析比较了年龄小于50岁和大于50岁的患者中，初次手术和二次手术进行RHA的结果。
在PubMed上查询描述患者年龄、手术治疗和适当结局指标的个体患者数据的文章。文章根据患者年龄是否小于50岁和大于50岁进行分组，在这些年龄组内，再根据置换术是作为初次手术还是二次手术进行分组。
年龄小于50岁组和大于50岁组在梅奥肘关节功能评分（P = 0.79）和植入物翻修/取出方面（P = 0.32）无显著差异。在年龄小于50岁组中，初次手术进行的RHA的平均梅奥肘关节功能评分显著高于二次手术进行的RHA（P = 0.001）。在年龄大于50岁组中，比较初次手术和二次手术时，植入物翻修/取出的相对风险为2.39（95%置信区间，2.12 - 2.69）（P = 0.11）。
平均随访48个月时，50岁以下患者的RHA有令人满意的结果，与50岁以上患者的结果相当。在两个年龄组中，初次手术进行的置换术与二次手术进行的置换术相比，显示出更好的结果。我们的研究结果为面对可能无法进行固定的年轻成年桡骨头骨折患者而面临多方面决策的外科医生提供了指导。了解桡骨头植入物的年龄特异性表现是手术治疗决策的重要组成部分。
