初次反向肩关节置换术失败后的翻修效果。

IF 4.9 1区 医学 Q1 ORTHOPEDICS Bone & Joint Journal Pub Date : 2024-11-01 DOI:10.1302/0301-620X.106B11.BJJ-2024-0032.R1
Olivia O'Malley, Joanna Craven, Andrew Davies, Sanjeeve Sabharwal, Peter Reilly
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引用次数: 0

摘要

目的:反向肩关节置换术(RSA)已成为英国最常用的肩关节置换术类型,因此需要更好地了解RSA失败后的翻修结果。本研究的目的是系统地回顾现有证据,以确定患者报告的结果指标以及接受RSA翻修术患者的再次翻修率和并发症发生率:方法:检索了 MEDLINE、Embase、CENTRAL 和 Cochrane 系统综述数据库。纳入的研究涉及因任何适应症接受原发性RSA翻修的成年患者。因全肩关节置换术或半关节置换术失败而接受RSA的患者除外。通过随机效应荟萃分析评估了术前和术后的肩关节评分,以确定平均差异。同时还计算了再次翻修率和并发症发生率:最初的搜索结果有 3,166 项,在去除重复内容并进行筛选后,确定了 13 项研究,共计 1,042 项 RSA。所有研究都报告了术前和术后肩关节评分的增加。将 RSA 修订为进一步 RSA 后,美国肩肘外科医生评分显著增加(平均差异为 20.78(95% CI 8.16 至 33.40);P = 0.001)。据报道,最终随访时的再次复发率为 9% 至 32%,一年内的再次复发率为 14%,五年内的再次复发率为 23%。所有研究的并发症发生率在 18.5% 到 36% 之间,总发生率为 29%:结论:这是对RSA翻修后效果进行的最大规模的系统性回顾。我们发现翻修手术后功能效果有所改善,但再次翻修率和并发症发生率较高,在计划翻修手术时应加以考虑。
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Outcomes following revision of a failed primary reverse shoulder arthroplasty.

Aims: Reverse shoulder arthroplasty (RSA) has become the most common type of shoulder arthroplasty used in the UK, and a better understanding of the outcomes after revision of a failed RSA is needed. The aim of this study was to review the current evidence systematically to determine patient-reported outcome measures and the rates of re-revision and complications for patients undergoing revision of a RSA.

Methods: MEDLINE, Embase, CENTRAL, and the Cochrane Database of Systematic Reviews were searched. Studies involving adult patients who underwent revision of a primary RSA for any indication were included. Those who underwent a RSA for failure of a total shoulder arthroplasty or hemiarthroplasty were excluded. Pre- and postoperative shoulder scores were evaluated in a random effects meta-analysis to determine the mean difference. The rates of re-revision and complications were also calculated.

Results: The initial search elicited 3,166 results and, following removal of duplicates and screening, 13 studies with a total of 1,042 RSAs were identified. An increase in shoulder scores pre- to postoperatively was reported in all the studies. Following revision of a RSA to a further RSA, there was a significant increase in the American Shoulder and Elbow Surgeons Score (mean difference 20.78 (95% CI 8.16 to 33.40); p = 0.001). A re-revision rate at final follow-up ranging from 9% to 32%, a one-year re-revision rate of 14%, and a five-year re-revision rate of 23% were reported. The complication rate in all the studies was between 18.5% and 36%, with a total incidence of 29%.

Conclusion: This is the largest systematic review of the outcomes following revision of a RSA. We found an improvement in functional outcomes after revision surgery, but the rates of re-revision and complications are high and warrant consideration when planning a revision procedure.

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来源期刊
Bone & Joint Journal
Bone & Joint Journal ORTHOPEDICS-SURGERY
CiteScore
9.40
自引率
10.90%
发文量
318
期刊介绍: We welcome original articles from any part of the world. The papers are assessed by members of the Editorial Board and our international panel of expert reviewers, then either accepted for publication or rejected by the Editor. We receive over 2000 submissions each year and accept about 250 for publication, many after revisions recommended by the reviewers, editors or statistical advisers. A decision usually takes between six and eight weeks. Each paper is assessed by two reviewers with a special interest in the subject covered by the paper, and also by members of the editorial team. Controversial papers will be discussed at a full meeting of the Editorial Board. Publication is between four and six months after acceptance.
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