半肩关节置换与反式全肩关节置换治疗老年复杂肱骨近端骨折的Meta分析  

Hemiarthroplasty versus reverse shoulder arthroplasty for complex proximal humeral fractures in the aged:a meta-analysis

作　　者：杨茂赓 刘义[1] 杨浩[1] 陈永成 杨彦熙 吴迪[1] Yang Maogeng;Liu Yi;Yang Hao;Chen Yongcheng;Yang Yanxi;Wu Di(Trauma Center,The First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院创伤中心,650032

出　　处：《中华创伤骨科杂志》2021年第10期900-905,共6页Chinese Journal of Orthopaedic Trauma

基　　金：云南省科技重点研发项目(2018BA064);云岭产业技术领军人才项目;云南省骨关节疾病临床医学中心项目(ZX2019-03-04)。

摘　　要：目的系统评价老年复杂肱骨近端骨折患者进行半肩关节置换术(HA)与反式全肩关节置换术(RSA)的优劣。方法计算机检索Pubmed、the Cochrane Library、EMBASE、中国知网、万方数据、维普等数据库,查找2000~2020年国内外发表的HA和RSA治疗老年(>60岁)肱骨近端骨折的文献。根据设定的纳入和排除标准过滤文献并进行质量评价,提取放射学和功能结果的数据,采用Stata 14.0软件分析数据。结果共纳入11篇研究771例患者。Meta分析结果显示:RSA组在前屈活动范围(SMD=-1.043,95%CI:-1.551~-0.534,P<0.001)、外展活动范围(SMD=-0.811,95%CI:-1.470~-0.153,P=0.016)、Constant评分(SMD=-0.699,95%CI:-1.118~-0.280,P=0.001)、美国肩肘外科评分(SMD=-0.931,95%CI:-1.256~-0.606,P<0.001)、肩关节简明测试评分(SMD=-0.598,95%CI:-1.181~-0.016,P=0.044)等方面优于HA组。HA组有更高的并发症发生率(RR=2.14,95%CI:1.11~4.14,P=0.024)、关节僵硬率(RR=6.467,95%CI:1.923~21.755,P=0.003)以及翻修率(RR=5.796,95%CI:1.927~17.434,P=0.002)。在结节愈合率(RR=0.850,95%CI:0.669~1.080,P=0.182)、内旋活动(SMD=0.536,95%CI:-0.394~1.466,P=0.259)、外旋活动(SMD=-0.366,95%CI:-0.916~0.184,P=0.192)、内置物感染(RR=1.550,95%CI:0.330~7.286,P=0.579)、肩、臂及手上肢功能评价量表(SMD=0.286,95%CI:-0.278~0.850,P=0.320)、视觉模拟评分(SMD=0.440,95%CI:-0.113~0.993,P=0.119)差异无统计学意义,但RSA组的Constant疼痛评分优于HA组(SMD=-1.101,95%CI:-2.090~-0.112,P=0.029)。结论对于60岁以上的复杂肱骨近端骨折患者,RSA是一种更有效的外科干预。与HA相比,RSA的早期到中期随访拥有更好的临床疗效。Objective To compare the advantages and disadvantages of hemiarthroplasty(HA)and reverse shoulder arthroplasty(RSA)in the treatment of complex proximal humeral fractures in the elderly patients.Methods Pubmed,the Cochrane Library,EMBASE,and Chinese databases like CNKI,Wanfang Data and Weipu were searched for studies comparing HA and RSA in the treatment of complex proximal humeral fractures in the elderly(>60 years)from 2000 to 2020.After the studies were included and excluded by a set of inclusion and exclusion criteria and evaluated for their quality,their radiological and functional data were extracted and analyzed using software Stata 14.0.Results Included in this meta-analysis were 11 studies with a total of 771 patients.RSA was superior to HA in outcomes like forward flexion(SMD=-1.043,95%CI:-1.551 to-0.534,P=0.000),abduction(SMD=-0.811,95%CI:-1.470 to-0.153,P=0.016),Constant score(SMD=-0.699,95%CI:-1.118 to-0.280,P=0.001),American Shoulder Elbow Surgeons’Form(ASES)(SMD=-0.931,95%CI:-1.256 to-0.606,P<0.001),and Simple Shoulder Test(SST)(SMD=-0.598,95%CI:-1.181 to-0.016,P=0.044).HA led to a higher complication rate(RR=2.14,95%CI:1.11 to 4.14,P=0.024),a higher joint stiffness rate(RR=6.467,95%CI:1.923 to 21.755,P=0.003)and a higher revision rate(RR=5.796,95%CI:1.927 to 17.434,P=0.002).There were no statistically significant differences between RSA and HA in tuber healing rate(RR=0.850,95%CI:0.669 to 1.080,P=0.182),internal rotation(SMD=0.536,95%CI:-0.394 to 1.466,P=0.259),external rotation(SMD=-0.366,95%CI:-0.916 to 0.184,P=0.192),implant infection(RR=1.550,95%CI:0.330 to 7.286,P=0.579)or Disabilities of the Arm,Shoulder and Hand(DASH)score(SMD=0.286,95%CI:-0.278 to 0.850,P=0.032).Although there was no significant difference between RSA and HA in visual analogue scale(VAS)score(SMD=0.440,95%CI:-0.113 to 0.993,P=0.119),RSA scored better(SMD=-1.101,95%CI:-2.090 to-0.112,P=0.029).Conclusion For elderly patients(>60 years)with complex proximal humeral fracture,RSA may be a more effective surgical intervention w

关 键 词：肩骨折 手术后并发症 生活质量 半肩关节置换 反式全肩关节置换 

分 类 号：R687.3[医药卫生—骨科学]