全肩关节置换术和人工半肩关节置换术后患者报告的结局：国家关节登记处数据分析。
Patient-reported outcomes following total shoulder arthroplasty and hemiarthroplasty: an analysis of data from the National Joint Registry.
机构信息
Department of Bioengineering, Imperial College London, London, UK.
Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK.
出版信息
J Shoulder Elbow Surg. 2024 Nov;33(11):2411-2420. doi: 10.1016/j.jse.2024.01.053. Epub 2024 Mar 22.
BACKGROUND
Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) are used in the management of end-stage glenohumeral arthritis. Improvement in shoulder function and resolution of symptoms are high priorities for patients. The aim of this study was to compare patient-reported outcome measures (PROMs) following TSA and HA.
METHODS
Records from the National Joint Registry of England, Wales, Northern Ireland, and the Isle of Man were linked to the PROMs data set. The study included anatomic shoulder arthroplasties performed for osteoarthritis in patients with an intact rotator cuff. Patients with preoperative and postoperative Oxford Shoulder Scores (OSSs) were included. The improvement in OSS at 6 months and 5 years and the trend in scores over time were analyzed for each prosthesis. A cohort of 2002 patients were matched on 10 variables using propensity scores. OSSs at 6 months following TSA vs. HA were compared in the matched sample.
RESULTS
There was a significant improvement in the OSS in both groups (P < .001). At 6 months, the OSSs were superior following TSA compared with HA (median 42 vs. 36, P < .001). The median score at 5 years was 44 following TSA and 35 following HA. Score distributions were skewed toward the maximum score. The highest possible score (48) was achieved in 28% (134 of 478) of TSAs and 9% (20 of 235) of HAs at 5 years. The improvement in the preoperative to 6-month OSS reached the minimal clinically important difference of 5.5 in 92% (1653 of 1792) of TSAs and in 80% (416 of 523) of HAs. At 5 years, this improvement was maintained in 91% (339 of 374) of TSAs and 78% (136 of 174) of HAs.
CONCLUSION
TSA resulted in superior OSSs at 6 months in patients with osteoarthritis. The median OSS improved from 6 months to 5 years following TSA; however, there was a small decline in scores following HA. A ceiling effect was shown in the OSS following TSA at 5 years.
背景
全肩关节置换术（TSA）和人工肱骨头置换术（HA）用于治疗终末期肩关节炎。改善肩部功能和缓解症状是患者的首要目标。本研究旨在比较 TSA 和 HA 术后患者报告的结果测量（PROMs）。
方法
将英格兰、威尔士、北爱尔兰和马恩岛国家关节登记处的记录与 PROMs 数据集相关联。该研究纳入了因肩袖完整的骨关节炎而接受解剖型肩关节置换术的患者。纳入了术前和术后 Oxford 肩部评分（OSS）的患者。分析了每种假体 6 个月和 5 年时 OSS 的改善情况以及随时间的评分趋势。使用倾向评分对 2002 例患者进行了 10 个变量的匹配。在匹配样本中比较 TSA 与 HA 术后 6 个月的 OSS。
结果
两组 OSS 均有显著改善（P<0.001）。6 个月时，TSA 后的 OSS 优于 HA（中位数 42 对 36，P<0.001）。5 年时，TSA 后的中位数评分为 44，HA 为 35。评分分布向最高分倾斜。5 年时，28%（478 例中的 134 例）的 TSA 和 9%（235 例中的 20 例）达到了最高可能的 48 分。从术前到 6 个月 OSS 的改善达到了 5.5 的最小临床重要差异，92%（1792 例中的 1653 例）的 TSA 和 80%（523 例中的 416 例）的 HA 达到了这一水平。5 年时，这一改善在 91%（374 例中的 339 例）的 TSA 和 78%（174 例中的 136 例）的 HA 中得以维持。
结论
在骨关节炎患者中，TSA 在 6 个月时导致 OSS 更高。TSA 后从 6 个月到 5 年 OSS 中位数改善；然而，HA 后评分略有下降。TSA 在 5 年后的 OSS 出现了上限效应。
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