Kevin A. Hao, Caroline T. Gutowski, Victoria E. Bindi, Ramesh C. Srinivasan, Jonathan O. Wright, Joseph J. King, Thomas W. Wright, Catherine J. Fedorka, Bradley S. Schoch, Keegan M. Hones
{"title":"针对肱骨近端大块骨质缺失的反向同种异体假体复合重建与内假体重建：疗效与并发症的系统回顾与 Meta 分析","authors":"Kevin A. Hao, Caroline T. Gutowski, Victoria E. Bindi, Ramesh C. Srinivasan, Jonathan O. Wright, Joseph J. King, Thomas W. Wright, Catherine J. Fedorka, Bradley S. Schoch, Keegan M. Hones","doi":"10.1007/s43465-024-01248-7","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>This systematic review and meta-analysis sought to compare the clinical outcomes after proximal humerus reconstruction with a reverse allograft-prosthetic composite (APC) versus reverse endoprosthesis.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Per PRISMA guidelines, we queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles reporting clinical outcomes of reverse APC or reverse endoprosthesis reconstruction of the proximal humerus for massive bone loss secondary to tumor, fracture, or failed arthroplasty. We compared postoperative range of motion, outcome scores, and the incidence of complications and revision surgery.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Of 259 unique articles, 18 articles were included (267 APC, 260 endoprosthesis). There were no significant differences between the APC and endoprosthesis cohort for postoperative forward elevation (<i>P</i> = .231), external rotation (<i>P</i> = .634), ASES score (<i>P</i> = .420), Constant score (<i>P</i> = .414), MSTS (<i>P</i> = .815), SST (<i>P</i> = .367), or VAS (<i>P</i> = .714). Rate of complications was 15% (31/213) in the APC cohort and 19% (27/144) in the endoprosthesis cohort. The rate of revision surgery was 12% after APC cohort and 7% after endoprosthesis. APC-specific complications included a 10% APC nonunion/malunion/resorption rate and 6% APC fracture/fragmentation rate.</p><h3 data-test=\"abstract-sub-heading\">Discussion</h3><p>Reverse APC and endoprosthesis are reasonable options for proximal humerus reconstruction. APC carries additional risks for complications, warranting evaluation of patients’ healing capacity and surgeon experience.</p><h3 data-test=\"abstract-sub-heading\">Level of Evidence</h3><p>Level IV; Systematic Review.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.1000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Reverse Allograft Prosthetic-Composite Versus Endoprosthesis Reconstruction for Massive Proximal Humerus Bone Loss: A Systematic Review and Meta-analysis of Outcomes and Complications\",\"authors\":\"Kevin A. Hao, Caroline T. Gutowski, Victoria E. Bindi, Ramesh C. Srinivasan, Jonathan O. Wright, Joseph J. King, Thomas W. Wright, Catherine J. Fedorka, Bradley S. Schoch, Keegan M. Hones\",\"doi\":\"10.1007/s43465-024-01248-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3 data-test=\\\"abstract-sub-heading\\\">Background</h3><p>This systematic review and meta-analysis sought to compare the clinical outcomes after proximal humerus reconstruction with a reverse allograft-prosthetic composite (APC) versus reverse endoprosthesis.</p><h3 data-test=\\\"abstract-sub-heading\\\">Methods</h3><p>Per PRISMA guidelines, we queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles reporting clinical outcomes of reverse APC or reverse endoprosthesis reconstruction of the proximal humerus for massive bone loss secondary to tumor, fracture, or failed arthroplasty. We compared postoperative range of motion, outcome scores, and the incidence of complications and revision surgery.</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>Of 259 unique articles, 18 articles were included (267 APC, 260 endoprosthesis). There were no significant differences between the APC and endoprosthesis cohort for postoperative forward elevation (<i>P</i> = .231), external rotation (<i>P</i> = .634), ASES score (<i>P</i> = .420), Constant score (<i>P</i> = .414), MSTS (<i>P</i> = .815), SST (<i>P</i> = .367), or VAS (<i>P</i> = .714). Rate of complications was 15% (31/213) in the APC cohort and 19% (27/144) in the endoprosthesis cohort. The rate of revision surgery was 12% after APC cohort and 7% after endoprosthesis. APC-specific complications included a 10% APC nonunion/malunion/resorption rate and 6% APC fracture/fragmentation rate.</p><h3 data-test=\\\"abstract-sub-heading\\\">Discussion</h3><p>Reverse APC and endoprosthesis are reasonable options for proximal humerus reconstruction. 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Reverse Allograft Prosthetic-Composite Versus Endoprosthesis Reconstruction for Massive Proximal Humerus Bone Loss: A Systematic Review and Meta-analysis of Outcomes and Complications
Background
This systematic review and meta-analysis sought to compare the clinical outcomes after proximal humerus reconstruction with a reverse allograft-prosthetic composite (APC) versus reverse endoprosthesis.
Methods
Per PRISMA guidelines, we queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles reporting clinical outcomes of reverse APC or reverse endoprosthesis reconstruction of the proximal humerus for massive bone loss secondary to tumor, fracture, or failed arthroplasty. We compared postoperative range of motion, outcome scores, and the incidence of complications and revision surgery.
Results
Of 259 unique articles, 18 articles were included (267 APC, 260 endoprosthesis). There were no significant differences between the APC and endoprosthesis cohort for postoperative forward elevation (P = .231), external rotation (P = .634), ASES score (P = .420), Constant score (P = .414), MSTS (P = .815), SST (P = .367), or VAS (P = .714). Rate of complications was 15% (31/213) in the APC cohort and 19% (27/144) in the endoprosthesis cohort. The rate of revision surgery was 12% after APC cohort and 7% after endoprosthesis. APC-specific complications included a 10% APC nonunion/malunion/resorption rate and 6% APC fracture/fragmentation rate.
Discussion
Reverse APC and endoprosthesis are reasonable options for proximal humerus reconstruction. APC carries additional risks for complications, warranting evaluation of patients’ healing capacity and surgeon experience.
期刊介绍：
IJO welcomes articles that contribute to Orthopaedic knowledge from India and overseas. We publish articles dealing with clinical orthopaedics and basic research in orthopaedic surgery. Articles are accepted only for exclusive publication in the Indian Journal of Orthopaedics. Previously published articles, articles which are in peer-reviewed electronic publications in other journals, are not accepted by the Journal. Published articles and illustrations become the property of the Journal. The copyright remains with the journal. Studies must be carried out in accordance with World Medical Association Declaration of Helsinki.
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