Levy Hannah A, Szeto Stanley, O Starks Alexandria, Davis Daniel E
Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
Shoulder Elbow. 2023 Nov;15(3 Suppl):6-18. doi: 10.1177/17585732221099200. Epub 2022 May 12.
Salvage reverse shoulder arthroplasty (RSA) for failed proximal humerus fractures (PHFs) fixation and hemiarthroplasty (HA) may maximize outcomes in the absence of tuberosity healing or a chronically torn rotator cuff. The purpose of this systematic review was to examine the improvement in clinical outcomes for patients after revision RSA was performed for failed PHFs fixation or HA.
An electronic database search of SCOPUS, PubMed, Embase, MEDLINE, SPORTDiscus, CINAHL, and ClinicalTrials.gov was performed. A meta-analysis was carried out to determine weighted mean outcome differences between two primary intervention cohorts (failed fixation: open reduction and internal fixation, intramedullary nail, or K-wire vs. failed HA).
Fifteen studies were included (primary fixation: 208 patients; HA: 162 patients). Patients improved meaningfully in all clinical outcomes after revision surgery (constant: 18.5-48.3; abduction: 44-95; forward flexion: 47-107; external rotation: 5-10), with a 16.2% complication and 9.4% revision rate. The failed fixation group performed significantly better than the failed HA group in postoperative constant (fixation: 53.3 vs. HA: 45.1, = 0.016) and shoulder abduction (fixation: 102 vs. HA: 87, = 0.026).
RSA is a successful revision intervention for primary PHF operative failures with the greatest benefit for failures of primary fixation versus HA.
对于肱骨近端骨折（PHF）内固定失败和半关节成形术（HA）失败的患者，挽救性反肩关节置换术（RSA）在不存在结节愈合或肩袖长期撕裂的情况下可能使治疗效果最大化。本系统评价的目的是研究对PHF内固定失败或HA失败的患者进行翻修RSA后临床疗效的改善情况。
对SCOPUS、PubMed、Embase、MEDLINE、SPORTDiscus、CINAHL和ClinicalTrials.gov进行电子数据库检索。进行荟萃分析以确定两个主要干预队列（内固定失败：切开复位内固定、髓内钉或克氏针与HA失败）之间的加权平均疗效差异。
纳入15项研究（初次固定：208例患者；HA：162例患者）。翻修手术后所有临床疗效均有显著改善（常数评分：18.5 - 48.3；外展：44 - 95；前屈：47 - 107；外旋：5 - 10），并发症发生率为16.2%，翻修率为9.4%。内固定失败组在术后常数评分（固定：53.3 vs. HA：45.1，P = 0.016）和肩关节外展（固定：102 vs. HA：87，P = 0.026）方面显著优于HA失败组。
RSA是对原发性PHF手术失败进行翻修的成功干预措施，对于原发性固定失败的患者比HA失败的患者受益更大。
