Lu Victor Yan Zhe, Shah Halia, Alshaber Zainab, Limonard Aaron, Domos Peter
Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong.
St George's, University of London, SW17 0RE, United Kingdom.
J Clin Orthop Trauma. 2025 Mar 22;65:102982. doi: 10.1016/j.jcot.2025.102982. eCollection 2025 Jun.
Proximal humerus fractures (PHFs) are a common injury experienced by elderly patients, however there is no consensus regarding the best treatment option. Recently, the use of reverse shoulder arthroplasty (RSA) in elderly patients with complex fractures is increasing. This systematic review and meta-analysis will compare the outcomes between RSA and non-operative treatment in 3- or 4-part PHFs in the elderly.
This study was conducted according to the PRISMA statement protocol and registered in PROSPERO (CRD42023439647). Searches on four databases (Medline, Embase, Web of Science, and Cochrane Library) were performed, and comparative studies which compared the outcomes of using RSA with conservative management were included. Demographic data, patient related outcome measures (PROMs), and complications rates were collected. Data were pooled using a random-effects model. Heterogeneity was determined using the I statistic and Cochran's Q test.
Six studies involving 439 patients (mean age 79.0 years old; 12.1 % male) were analysed. The average Charlson co-morbidity index (CCI) was 3.74 and follow-up time was 26.0 months. Compared to the non-operative cohort, the RSA cohort had better VAS scores (1.0 versus 0.575; p = 0.047), Constant-Murley scores (66.3 versus 71; p = 0.114), active forward flexion (121.5° versus 100°; p = 0.023; I = 35 %), external rotation (34.8° vs 23.1°; p = 0.020), and internal rotation (Constant score 5.44 versus 4.28; p = 0.169). There is no difference in the overall risk of complications (8.2 % versus 6.0 %; RR = 1.00; p = 0.993), but those treated by RSA have a higher risk of needing subsequent revision surgery (3.7 % versus 2.8 %; p = 0.640; I = 25 %).
In the short-term, elderly patients with complex PHFs treated with RSA may have decreased pain, increased Constant-Murley scores, and increased ROM compared with patients treated non-operatively, at the expense of a higher risk of needing subsequent surgery. However, moderate between-study heterogeneity in effect sizes and the retrospective nature of included studies may limit the clinical applications of conclusions obtained in this review.
III.
肱骨近端骨折（PHF）是老年患者常见的损伤，但对于最佳治疗方案尚无共识。近年来，老年复杂骨折患者中使用反肩关节置换术（RSA）的情况日益增多。本系统评价和荟萃分析将比较老年患者三部分或四部分PHF采用RSA与非手术治疗的疗效。
本研究按照PRISMA声明方案进行，并在PROSPERO（CRD42023439647）注册。检索了四个数据库（Medline、Embase、Web of Science和Cochrane图书馆），纳入比较RSA与保守治疗疗效的对照研究。收集人口统计学数据、患者相关结局指标（PROM）和并发症发生率。采用随机效应模型合并数据。使用I统计量和Cochrane Q检验确定异质性。
分析了6项研究，共439例患者（平均年龄79.0岁；男性占12.1%）。平均Charlson合并症指数（CCI）为3.74，随访时间为26.0个月。与非手术组相比，RSA组的视觉模拟评分（VAS）更好（1.0对0.575；p = 0.047）、Constant-Murley评分（66.3对71；p = 0.114）、主动前屈（121.5°对100°；p = 0.023；I = 35%）、外旋（34.8°对23.1°；p = 0.020）和内旋（Constant评分5.44对4.28；p = 0.169）。总体并发症风险无差异（8.2%对6.0%；RR = 1.00；p = 0.993），但接受RSA治疗的患者需要后续翻修手术的风险更高（3.7%对2.8%；p = 0.640；I = 25%）。
短期内，与非手术治疗的患者相比，采用RSA治疗的老年复杂PHF患者疼痛可能减轻、Constant-Murley评分增加、关节活动度增加，但代价是需要后续手术的风险更高。然而，研究效应量之间存在中度异质性以及纳入研究的回顾性性质可能会限制本综述所得结论的临床应用。
III级
