PDF(Pubmed)
Abstract：
Background: The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options, reverse shoulder arthroplasty (RSA) and non-operative treatment (NOT) appear to provide the best results. Evidence to guide the choice between the two is sparse. Therefore, this review provides an overview of the available evidence on RSA versus NOT. Methods: Studies comparing complex proximal humerus fractures in patients aged >65 years treated either with RSA or NOT were included for systematic review and direct comparison via pooled analysis of patient-rated outcome and range of motion. Indirect comparison of case series and non-comparative studies on either treatment was performed separately. Results: Three comparative studies including 77 patients treated with RSA and 81 treated non-operatively were analysed. The RSA group scored better for both the Constant-Murley score (mean difference 6 points) and DASH score (mean difference 8 points). No differences were detected in ASES, PENN score, pain scores, or range of motion between treatment groups. The most common complications for RSA were infection (3%), nerve injury (2%), and dislocation (2%). Reoperation was required in 5%. In the NOT group, common complications included malunion (42%), osteonecrosis (25%), and non-union (3%); no reoperation was required. Patient satisfaction was equal in both groups. Conclusions: The functional outcomes and range of motion after RSA seemed satisfactory and potentially superior to NOT in elderly patients. Patient satisfaction was comparable despite a high malunion and osteonecrosis rate in the non-operative treatment group, which did not require re-interventions.
摘要：
背景：老年患者复杂肱骨近端骨折的治疗方法尚未完全阐明。在所有的治疗选择中,反向肩关节置换术（RSA）和非手术治疗（NOT）似乎提供了最好的结果。指导两者之间选择的证据很少。因此,本综述概述了RSA与NOT的现有证据.方法：纳入比较年龄>65岁接受RSA或NOT治疗的患者的复杂肱骨近端骨折的研究，以进行系统评价，并通过对患者评估结果和活动范围的汇总分析进行直接比较。分别进行病例系列和非比较研究的间接比较。结果：分析了三项比较研究，包括77例接受RSA治疗的患者和81例非手术治疗的患者。RSA组在Constant-Murley得分（平均差6分）和DASH得分（平均差8分）方面得分较高。在ASES中没有检测到差异，PENN得分,疼痛评分,或治疗组之间的运动范围。RSA最常见的并发症是感染（3％），神经损伤（2%），和位错(2%)。5%需要再次手术。在NOT组中,常见并发症包括畸形愈合（42%），骨坏死（25%），和非工会（3％）；不需要再次手术。两组患者满意度相等。结论：在老年患者中，RSA术后的功能结果和活动范围似乎令人满意，并且可能优于NOT。尽管非手术治疗组的畸形愈合和骨坏死率高，但患者满意度相当。这不需要重新干预。
