背景:解剖和反向肩关节置换术(TSA,RSA)近年来的受欢迎程度激增。虽然RSA被食品和药物管理局(FDA)批准用于肩袖撕裂性关节病的病例,适应症已经扩大到包括,其中,原发性肱骨关节炎(GHOA)。
方法:PubMed,科克伦,和谷歌学者(第1-20页)被查询到2023年11月。纳入标准包括比较TSA与RSA在治疗完整肩袖GHOA不良事件方面的效用的研究。患者报告的结果,和运动范围。ROBINS-I工具用于评估纳入的非随机研究中的偏倚风险,采用ReviewManager5.4进行统计分析。P值<0.05被认为是显著的。
结果:14项研究符合上述纳入标准。12项研究报告了不良结局,与TSA相比,RSA组的并发症(比值比=0.54,p=0.004)和再手术(比值比=0.31,p<.001)发生率较低,平均随访时间为3.4年.四项研究报告了SPADI和UCLA的得分,而5人报告了SST评分。这些研究显示了优越的SPADI(p=0.040),加州大学洛杉矶分校(p=0.006),RSA组的SST(p=0.040)评分。对于其他患者报告的结果,没有发现显着差异。十项研究报告了运动范围,与TSA组相比,RSA组的外旋转明显较低(p<.001),而其他运动范围参数无统计学差异。
结论:本研究为RSA作为GHOA和完整肩袖患者的合理手术选择提供了支持。与TSA相比,不良事件发生率较低,结局较好,尽管以减少外部旋转为代价。作为共享决策过程的一部分,患者教育和咨询是决定最佳治疗的关键。以及设定适当的期望。
BACKGROUND: Anatomic and reverse shoulder arthroplasty (TSA, RSA) have surged in popularity in recent years. While RSA is Food and Drug Administration (FDA) approved for cases of rotator cuff tear arthropathy, indications have expanded to include, among others, primary glenohumeral osteoarthritis (GHOA).
METHODS: PubMed, Cochrane, and Google Scholar (pages 1-20) were queried through November 2023. Inclusion criteria consisted of studies that compared the utility of TSA to that of RSA for the treatment of GHOA with intact rotator cuff with respect to adverse events, patient-reported outcomes, and range of motion. The ROBINS-I tool was used to assess the risk of bias in the included non-randomized studies, and Review Manager 5.4 was used for statistical analysis. P-values <0.05 were deemed significant.
RESULTS: Fourteen studies met the above inclusion criteria. Twelve studies reported adverse outcomes, with the RSA group having a lower rate of complications (odds-ratio=0.54, p=0.004) and reoperations (odds-ratio=0.31, p<.001) relative to TSA at an average follow-up of 3.4 years. Four studies reported SPADI and UCLA scores, while five reported SST scores. These studies showed superior SPADI (p=0.040), UCLA(p=0.006), and SST(p=0.040) scores among the RSA group. No significant differences were seen with regards to other patient reported outcomes. Ten studies reported on range of motion, and the RSA group had a significantly lower external rotation relative to the TSA group (p<.001) while other range of motion parameters did not show statistically significant differences.
CONCLUSIONS: The present study provides support for RSA as a reasonable surgical option for patients with GHOA and an intact rotator cuff, with lower rates of adverse events and better outcomes relative to TSA, although at the expense of decreased external rotation. Patient education and counseling is key in order to decide optimal treatment as part of a shared decision-making process, as well as setting appropriate expectations.