Lai Boyong, Zhang Sheng, Pan Junxi, Li An, Guo Ding, Peng Zhihua, Feng Qinghui
The Affiliated Traditional Chinese Medicine Hospital, Guangzhou Medical University, Guangzhou, China.
Front Med (Lausanne). 2024 Sep 6;11:1436000. doi: 10.3389/fmed.2024.1436000. eCollection 2024.
The clinical efficacy of reverse shoulder arthroplasty (RSA), hemiarthroplasty (HA), and non-surgical management in the treatment of proximal humeral fractures (PHFs) is inconclusive. This systematic review and meta-analysis compared the clinical outcomes of arthroplasty and non-surgical management of PHFs.
The databases of PubMed, Embase, Web of Science, and Cochrane Library were searched on 5 May 2023 for studies comparing arthroplasty and non-surgical treatment of PHFs. Both randomized controlled trials (RCTs) and non-randomized controlled trials (nRCTs), were included. Standard methodological quality assessments were conducted for both types of studies. The primary outcome was the Constant-Murley Score (CMS) after surgical or non-surgical treatment. Secondary study outcomes included the visual analog scale (VAS), range of motion, and complications. All functional scores and complications were subjected to subgroup and sensitivity analyses.
A total of four RCTs and six nRCTs were included in this study, which provided 508 patients in total for meta-analysis: 238 treated with arthroplasty and 270 treated non-surgically, of which 83 were treated with HA and 155 with RSA. All relevant information was collected, including functional scores, VAS, range of motion, and complications. The study found no significant difference in functional outcomes (mean difference, 2.82; 95% confidence interval, -0.49 to 6.14; = 0.10; = 77%) and complications (mean difference, 1.08; 95% confidence interval, 0.51-2.25; = 0.85; = 47%) between arthroplasty and non-surgical treatment. Both RCTs and nRCTs showed the same results. However, VAS scores were significantly lower in surgical treatment compared to non-surgical treatment. Subgroup and sensitivity analyses showed that RSA could achieve better functional scores than non-surgical treatment (mean difference, 6.00; 95% confidence interval, 1.97-10.03; = 0.004; = 0%), while the results for HA were not significant ( > 0.05).
There were no significant differences in complications between arthroplasty and non-surgical treatment for PHFs. RSA could achieve better functional results than non-surgical treatment, while HA could only achieve better forward flexion.
反肩关节置换术（RSA）、半关节置换术（HA）和非手术治疗在肱骨近端骨折（PHF）治疗中的临床疗效尚无定论。本系统评价和荟萃分析比较了PHF关节置换术和非手术治疗的临床结果。
于2023年5月5日检索PubMed、Embase、Web of Science和Cochrane图书馆数据库，以查找比较PHF关节置换术和非手术治疗的研究。纳入随机对照试验（RCT）和非随机对照试验（nRCT）。对这两种类型的研究均进行了标准的方法学质量评估。主要结局是手术或非手术治疗后的Constant-Murley评分（CMS）。次要研究结局包括视觉模拟量表（VAS）、活动范围和并发症。所有功能评分和并发症均进行亚组分析和敏感性分析。
本研究共纳入4项RCT和6项nRCT，共提供508例患者进行荟萃分析：238例行关节置换术，270例接受非手术治疗，其中83例行HA，155例行RSA。收集了所有相关信息，包括功能评分、VAS、活动范围和并发症。研究发现，关节置换术和非手术治疗在功能结局（平均差，2.82；95%置信区间，-0.49至6.14；P = 0.10；I² = 77%）和并发症（平均差，1.08；95%置信区间，0.51 - 2.25；P = 0.85；I² = 47%）方面无显著差异。RCT和nRCT均显示相同结果。然而，与非手术治疗相比，手术治疗的VAS评分显著更低。亚组分析和敏感性分析表明，RSA可获得比非手术治疗更好的功能评分（平均差，6.00；95%置信区间，1.97 - 10.03；P = 0.004；I² = 0%），而HA的结果不显著（P > 0.05）。
PHF关节置换术和非手术治疗在并发症方面无显著差异。RSA比非手术治疗能取得更好的功能结果，而HA仅能在向前屈曲方面取得更好效果。
