Bosch Thomas P, Beeres Frank J P, Ferree Steven, Schipper Inger B, Camenzind Roland S, Hoepelman Ruben J, Link Björn-Christian, Rompen Ingmar F, Babst Reto, van de Wall Bryan J M
Department of Health Sciences and Medicine, University of Lucerne, 6002 Luzern, Switzerland.
Department of Trauma Surgery, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands.
J Clin Med. 2024 Jun 6;13(11):3344. doi: 10.3390/jcm13113344.
: The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options, reverse shoulder arthroplasty (RSA) and non-operative treatment (NOT) appear to provide the best results. Evidence to guide the choice between the two is sparse. Therefore, this review provides an overview of the available evidence on RSA versus NOT. : Studies comparing complex proximal humerus fractures in patients aged >65 years treated either with RSA or NOT were included for systematic review and direct comparison via pooled analysis of patient-rated outcome and range of motion. Indirect comparison of case series and non-comparative studies on either treatment was performed separately. : Three comparative studies including 77 patients treated with RSA and 81 treated non-operatively were analysed. The RSA group scored better for both the Constant-Murley score (mean difference 6 points) and DASH score (mean difference 8 points). No differences were detected in ASES, PENN score, pain scores, or range of motion between treatment groups. The most common complications for RSA were infection (3%), nerve injury (2%), and dislocation (2%). Reoperation was required in 5%. In the NOT group, common complications included malunion (42%), osteonecrosis (25%), and non-union (3%); no reoperation was required. Patient satisfaction was equal in both groups. : The functional outcomes and range of motion after RSA seemed satisfactory and potentially superior to NOT in elderly patients. Patient satisfaction was comparable despite a high malunion and osteonecrosis rate in the non-operative treatment group, which did not require re-interventions.
老年患者复杂肱骨近端骨折的治疗方法尚未完全阐明。在所有治疗选择中，反肩关节置换术（RSA）和非手术治疗（NOT）似乎能提供最佳效果。指导在这两种方法之间做出选择的证据很少。因此，本综述概述了关于RSA与NOT的现有证据。：纳入了比较年龄>65岁的患者采用RSA或NOT治疗复杂肱骨近端骨折的研究，进行系统评价，并通过对患者自评结果和活动范围的汇总分析进行直接比较。对两种治疗方法的病例系列和非对照研究分别进行间接比较。：分析了三项比较研究，其中77例患者接受了RSA治疗，81例接受了非手术治疗。RSA组在Constant-Murley评分（平均差异6分）和DASH评分（平均差异8分）方面得分更高。治疗组之间在ASES、PENN评分、疼痛评分或活动范围方面未检测到差异。RSA最常见的并发症是感染（3%）、神经损伤（2%）和脱位（2%）。5%的患者需要再次手术。在NOT组，常见并发症包括畸形愈合（42%）、骨坏死（25%）和不愈合（3%）；无需再次手术。两组患者的满意度相同。：在老年患者中，RSA后的功能结果和活动范围似乎令人满意，可能优于NOT。尽管非手术治疗组的畸形愈合和骨坏死率较高，但无需再次干预，两组患者的满意度相当。
