Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, Germany.
Research Group "Mathematical Surgery", University Hospital Muenster, University of Muenster, 48149 Muenster, Germany.
Medicina (Kaunas). 2023 Sep 27;59(10):1728. doi: 10.3390/medicina59101728.
The proximal humeral fracture (PHF) is one of the most common fractures in elderly patients. A PHF might influence the quality of life (QoL) on several different levels, especially in elderly patients, but it is unclear which treatment option results in a better QoL outcome. Therefore, we aimed to systematically review the current literature for studies that have analyzed the QoL and pain of elderly patients treated either surgically or non-operatively for PHF. A comprehensive search of the literature was performed in the PubMed database from January to April 2023. Studies describing the QoL or the level of pain of patients older than 60 years with the EuroQoL-5 Dimension (EQ-5D) score or the visual analogue scale (VAS) after the treatment of PHF, either non-operatively (non-OP), with open-reduction and internal fixation using a locking plate (LPF), or with reverse total shoulder arthroplasty (RTSA) were included. Twelve studies were analyzed descriptively and the individual risk of bias was assessed using the ROB2 and ROBINS-I tools. A total of 12 studies with 712 patients at baseline were included (78% female sex, mean age 75.2 years). The reported VAS scores at 12-month follow-up (FU) ranged from 0.7 to 2.5. The calculated overall mean VAS score across all studies showed a decreasing tendency for all treatments, with an increasing FU time up to 12 months after PHF. None of the studies reported any significant differences of the EQ-5D across the groups. The overall calculated EQ-5D indices showed an increasing trend after 6-8 weeks FU, but did not differ significantly between the three treatments. In conclusion, the current literature suggests that there are no clinically important differences between the QoL or pain in elderly patients with PHF after non-operative treatment or surgical treatment with LPF or RTSA. However, the number of studies and level of evidence is rather low and further trials are urgently needed.
肱骨近端骨折（PHF）是老年患者最常见的骨折之一。PHF 可能会在多个不同层面上影响生活质量（QoL），尤其是在老年患者中，但哪种治疗方法能获得更好的 QoL 结果尚不清楚。因此，我们旨在系统地回顾目前的文献，分析接受手术或非手术治疗的 PHF 老年患者的 QoL 和疼痛情况。我们在 PubMed 数据库中进行了全面的文献检索，检索时间为 2023 年 1 月至 4 月。研究描述了年龄大于 60 岁的患者的 QoL 或疼痛水平，使用 EuroQoL-5 维度（EQ-5D）评分或视觉模拟量表（VAS）进行评估，这些患者接受 PHF 治疗后，非手术治疗（非手术治疗）、使用锁定钢板（LPF）进行切开复位内固定或接受反式全肩关节置换术（RTSA）。共有 12 项研究进行了描述性分析，并使用 ROB2 和 ROBINS-I 工具评估了个体的偏倚风险。共有 12 项研究纳入了 712 名基线患者（78%为女性，平均年龄 75.2 岁）。报告的 12 个月随访（FU）VAS 评分范围为 0.7 至 2.5。所有研究的计算总平均 VAS 评分显示出随着 FU 时间的增加而逐渐降低的趋势，直至 PHF 后 12 个月。没有研究报告 EQ-5D 在各组之间有任何显著差异。总体计算的 EQ-5D 指数在 FU 后 6-8 周后呈上升趋势，但在三种治疗方法之间没有显著差异。总之，目前的文献表明，在接受非手术治疗或使用 LPF 或 RTSA 进行手术治疗后，PHF 老年患者的 QoL 或疼痛之间没有明显的临床差异。然而，研究数量和证据水平较低，迫切需要进一步的试验。
