儿童人群肱骨头缺血性坏死的管理：一项系统评价
Management of osteonecrosis of the humeral head in the pediatric population: A systematic review.
作者信息
Desai Vineet M, Syed Akbar N, Batley Morgan, Wells Lawrence, Williams Brendan A
机构信息
Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Harvard Medical School, Boston, MA, USA.
出版信息
J Child Orthop. 2024 May 19;18(4):432-440. doi: 10.1177/18632521241254708. eCollection 2024 Aug.
PURPOSE
Humeral head osteonecrosis in the pediatric patients most often occurs in patients with underlying hemoglobinopathies, exposure to chronic corticosteroids, or after trauma. The purpose of this study was to perform a systematic review evaluating the prevalence, clinical characteristics, and management of humeral head osteonecrosis in the pediatric population.
METHODS
PubMed, Ovid MEDLINE, and Scopus were screened with the terms "osteonecrosis," "avascular necrosis," "pediatric," and "proximal humerus" on January 10, 2024. A total of 218 studies were screened, and 74 studies were evaluated for eligibility. Studies that reported on the prevalence and/or management of pediatric humeral head osteonecrosis were included. The systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.
RESULTS
Twelve studies met inclusion criteria: four retrospective case series, three prospective case series, one retrospective cohort study, one retrospective case-control study, and three case reports. A majority of the studies (67%) discussed chemotherapy-induced osteonecrosis of the humeral head. A total of 77 patients (106 shoulders) with humeral head osteonecrosis were identified. The overall prevalence of osteonecrosis of the humeral head across eight studies examining at-risk populations (underlying hemoglobinopathies or undergoing chemotherapy) was 2%. Intra-articular steroid injections, physical therapy, and activity modification are effective conservative management strategies. Additionally, core decompression and hemiarthroplasty are surgical treatment options.
CONCLUSIONS
The prevalence of osteonecrosis of the humeral head is low even among at-risk populations with associated medical conditions. A variety of conservative and surgical treatment options have been described, but no comparative evaluations of these modalities has been conducted.
LEVEL OF EVIDENCE
IV.
目的
小儿肱骨头骨坏死最常发生于患有潜在血红蛋白病、长期使用皮质类固醇或创伤后的患者。本研究的目的是进行一项系统评价，评估小儿人群中肱骨头骨坏死的患病率、临床特征及治疗方法。
方法
于2024年1月10日在PubMed、Ovid MEDLINE和Scopus数据库中以“骨坏死”“缺血性坏死”“小儿”和“肱骨近端”为关键词进行检索。共筛选出218项研究，其中74项研究评估了纳入资格。纳入报告小儿肱骨头骨坏死患病率和/或治疗方法的研究。本系统评价按照系统评价和Meta分析的首选报告项目指南进行。
结果
12项研究符合纳入标准：4项回顾性病例系列研究、3项前瞻性病例系列研究、1项回顾性队列研究、1项回顾性病例对照研究和3篇病例报告。大多数研究（67%）讨论了化疗引起的肱骨头骨坏死。共确定了77例（106个肩关节）肱骨头骨坏死患者。在八项针对高危人群（潜在血红蛋白病或接受化疗）的研究中，肱骨头骨坏死的总体患病率为2%。关节内注射类固醇、物理治疗和调整活动是有效的保守治疗策略。此外，髓芯减压和半关节置换是手术治疗选择。
结论
即使在患有相关疾病的高危人群中，肱骨头骨坏死的患病率也较低。已描述了多种保守和手术治疗选择，但尚未对这些治疗方式进行比较评估。
证据级别
IV级。
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