Iking Janette, Fischhuber Karen, Katthagen J Christoph, Oenning Sebastian, Raschke Michael J, Stolberg-Stolberg Josef, Köppe Jeanette
Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany.
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany.
PLoS One. 2025 Feb 27;20(2):e0317005. doi: 10.1371/journal.pone.0317005. eCollection 2025.
For surgical treatment of proximal humeral fractures (PHF) in older patients, there is no consensus if locked plate fixation (LPF) or reverse total shoulder arthroplasty (RTSA) yields better clinical results. The purpose of this study was to systematically review the clinical and functional outcomes of LPF and RTSA. We hypothesized that RTSA would outperform LPF in patients with PHF aged 65 years or older.
MATERIALS & METHODS: A comprehensive literature search was performed on PubMed and Google Scholar from 1 July 2022 up to 12 January 2024 by two independent reviewers. Comparative studies reporting on the functional outcome using the Constant-Murley score (CMS) in patients aged 65 years or older, treated after 2012 for PHF with LPF or RTSA and with a mean follow-up time of at least 12 months were included. Ten studies with 244 LPF and 287 RTSA patients were included into the statistical analysis. We used a frequentist network meta-analysis to assess the comparative effectiveness of the treatments. Individual risk of bias of the studies was assessed using the ROB2 and ROBINS-I tools.
Our network meta-analysis of the CMS resulted in the following order ranked from lowest to highest: LPF, LPF + screw augmentation, hemiarthroplasty (HA), RTSA + cemented stem, non-surgical treatment, LPF + fibular allograft, RTSA with an inclination angle of 135° (RTSA IA 135°), RTSA. However, none of the direct or indirect comparisons resulted in statistically noticeable differences.
In conclusion, functional superiority of either treatment method is still unknown, with even high-powered RCT not being able to detect statistically noticeable differences in terms of function. Patient-individual factors, such as bone quality, sex and age have to be included when making treatment decisions.
对于老年患者肱骨近端骨折（PHF）的手术治疗，锁定钢板固定（LPF）或反式全肩关节置换术（RTSA）哪种方法能产生更好的临床效果尚无共识。本研究的目的是系统评价LPF和RTSA的临床及功能结局。我们假设在65岁及以上的PHF患者中，RTSA的效果优于LPF。
由两名独立 reviewers 于2022年7月1日至2024年1月12日在PubMed和谷歌学术上进行了全面的文献检索。纳入2012年后接受LPF或RTSA治疗的65岁及以上PHF患者，使用Constant-Murley评分（CMS）报告功能结局且平均随访时间至少12个月的比较研究。10项研究共244例接受LPF治疗的患者和287例接受RTSA治疗的患者纳入统计分析。我们使用频率学派网状Meta分析来评估治疗的比较有效性。使用ROB2和ROBINS-I工具评估各研究的个体偏倚风险。
我们对CMS进行的网状Meta分析得出以下从低到高的排序：LPF、LPF+螺钉增强、半关节置换术（HA）、RTSA+骨水泥柄、非手术治疗、LPF+腓骨移植、倾斜角度为135°的RTSA（RTSA IA 135°）、RTSA。然而，直接或间接比较均未产生统计学上显著的差异。
总之，两种治疗方法的功能优越性仍不明确，即使是效能强大的随机对照试验也无法在功能方面检测到统计学上显著的差异。在做出治疗决策时，必须考虑患者个体因素，如骨质、性别和年龄。
