Abstract：
BACKGROUND: Patients with pre-existing neurologic disorders present a unique set of challenges for shoulder arthroplasty (SA) surgeons due to the presence of concomitant contractures, muscle weakness, and spasticity, which may affect outcomes and complication rates after shoulder arthroplasty. The goal of this systematic review was to evaluate the clinical and functional outcomes after SA in patients pre-existing with neurologic disorders, focusing on complication and reoperation rates.
METHODS: This systematic review was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines outlined by Cochrane Collaboration. A search of PubMed, the Medline Library, and EMBASE from inception until September 2023 was conducted to obtain studies reporting on outcomes after SA in patients with neurological disorders. Study demographics and information on outcomes including patient-reported outcomes and complication rates were collected. The methodological quality of included primary studies was appraised using the MINORS scoring system.
RESULTS: Twenty articles published between 1997 and 2023 met inclusion criteria. In total, 13,126 patients with neurological conditions with 7 different neurological disorders (Parkinson\'s disease (PD), epilepsy and seizures, cerebral palsy (CP), poliomyelitis, Charcot neuropathy (CN), cerebrovascular disease (CVD) and multiple sclerosis (MS)) were included. The mean patient age was 64.3 years (range, 33.0 - 75.8 years), 51.4% of patients were male, and the mean postoperative follow-up time was 5.1 years (range, 1.4 - 9.9 years). PD was the most reported neurological disorder (9 studies, 8,033 patients), followed by epilepsy (4 studies, 3,783 patients), and MS (1 study, 1,077 patients). While these patients did experience improvements in outcomes following SA, high complication and revision rates were noted.
CONCLUSIONS: Patients with neurologic disorders demonstrate improvements in pain and function after SA but have higher reported complication and revision rates when compared with patients without neurologic conditions. This systematic review offers valuable data for both the surgeon and patient regarding anticipated clinical results and possible complications from SA in patients with neurologic disorders that may aid in shared decision-making when considering SA.
METHODS: This systematic review was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines outlined by Cochrane Collaboration. A search of PubMed, the Medline Library, and EMBASE from inception until September 2023 was conducted to obtain studies reporting on outcomes after SA in patients with neurological disorders. Study demographics and information on outcomes including patient-reported outcomes and complication rates were collected. The methodological quality of included primary studies was appraised using the MINORS scoring system.
RESULTS: Twenty articles published between 1997 and 2023 met inclusion criteria. In total, 13,126 patients with neurological conditions with 7 different neurological disorders (Parkinson\'s disease (PD), epilepsy and seizures, cerebral palsy (CP), poliomyelitis, Charcot neuropathy (CN), cerebrovascular disease (CVD) and multiple sclerosis (MS)) were included. The mean patient age was 64.3 years (range, 33.0 - 75.8 years), 51.4% of patients were male, and the mean postoperative follow-up time was 5.1 years (range, 1.4 - 9.9 years). PD was the most reported neurological disorder (9 studies, 8,033 patients), followed by epilepsy (4 studies, 3,783 patients), and MS (1 study, 1,077 patients). While these patients did experience improvements in outcomes following SA, high complication and revision rates were noted.
CONCLUSIONS: Patients with neurologic disorders demonstrate improvements in pain and function after SA but have higher reported complication and revision rates when compared with patients without neurologic conditions. This systematic review offers valuable data for both the surgeon and patient regarding anticipated clinical results and possible complications from SA in patients with neurologic disorders that may aid in shared decision-making when considering SA.
摘要：
背景：由于伴随挛缩的存在，先前存在神经系统疾病的患者对肩关节成形术（SA）外科医生提出了一系列独特的挑战，肌肉无力,痉挛,这可能会影响肩关节置换术后的预后和并发症发生率。本系统评价的目的是评估先有神经系统疾病的患者在SA后的临床和功能结果。关注并发症和再手术率。
方法：本系统评价是根据CochraneCollaboration概述的系统评价和荟萃分析（PRISMA）首选报告项目进行的。搜索PubMed,Medline图书馆,和EMBASE从开始至2023年9月进行研究,以获得神经系统疾病患者SA后结局的报告.收集研究人口统计学和结果信息，包括患者报告的结果和并发症发生率。纳入的主要研究的方法学质量采用MINORS评分系统进行评价。
结果：1997年至2023年发表的20篇文章符合纳入标准。总的来说,13,126名患有7种不同神经系统疾病的神经系统疾病患者(帕金森病(PD)，癫痫和癫痫,脑瘫（CP），脊髓灰质炎,Charcot神经病（CN），包括脑血管疾病（CVD）和多发性硬化（MS）。患者平均年龄为64.3岁(范围，33.0-75.8年），51.4%的患者为男性,术后平均随访时间为5.1年(范围，1.4-9.9年）。PD是报告最多的神经系统疾病(9项研究，8033名患者），其次是癫痫（4项研究，3,783名患者），和MS（1项研究，1077名患者）。虽然这些患者在SA后的结果确实有所改善，观察到高并发症和翻修率.
结论：与没有神经系统疾病的患者相比，患有神经系统疾病的患者在SA后疼痛和功能得到改善，但报告的并发症和翻修率更高。这项系统评价为外科医生和患者提供了有关神经系统疾病患者SA的预期临床结果和可能的并发症的宝贵数据，这些数据可能有助于在考虑SA时做出共同的决策。
方法：本系统评价是根据CochraneCollaboration概述的系统评价和荟萃分析（PRISMA）首选报告项目进行的。搜索PubMed,Medline图书馆,和EMBASE从开始至2023年9月进行研究,以获得神经系统疾病患者SA后结局的报告.收集研究人口统计学和结果信息，包括患者报告的结果和并发症发生率。纳入的主要研究的方法学质量采用MINORS评分系统进行评价。
结果：1997年至2023年发表的20篇文章符合纳入标准。总的来说,13,126名患有7种不同神经系统疾病的神经系统疾病患者(帕金森病(PD)，癫痫和癫痫,脑瘫（CP），脊髓灰质炎,Charcot神经病（CN），包括脑血管疾病（CVD）和多发性硬化（MS）。患者平均年龄为64.3岁(范围，33.0-75.8年），51.4%的患者为男性,术后平均随访时间为5.1年(范围，1.4-9.9年）。PD是报告最多的神经系统疾病(9项研究，8033名患者），其次是癫痫（4项研究，3,783名患者），和MS（1项研究，1077名患者）。虽然这些患者在SA后的结果确实有所改善，观察到高并发症和翻修率.
结论：与没有神经系统疾病的患者相比，患有神经系统疾病的患者在SA后疼痛和功能得到改善，但报告的并发症和翻修率更高。这项系统评价为外科医生和患者提供了有关神经系统疾病患者SA的预期临床结果和可能的并发症的宝贵数据，这些数据可能有助于在考虑SA时做出共同的决策。
