Table_1_Fracture-Dedicated Prosthesis Promotes the Healing Rate of Greater Tuberosity in Reverse Shoulder Arthroplasty: A Meta-Analysis.DOCX

Introduction: Reverse shoulder arthroplasty (RSA) is becoming popular in the treatment of complex proximal humeral fractures (PHFs). Greater tuberosity healing may influence functional outcomes and range of motion (ROM) of shoulder after RSA. In addition, the design of prosthesis may impact the healing rate of greater tuberosity. The purpose of this study is to know: (1) does the healing of greater tuberosity affect the functional outcomes and ROM of shoulder? and (2) does the design of prosthesis affect the healing rate of greater tuberosity?
Materials and Methods: PubMed, Ovid/Embase, and the Cochrane Library were searched for studies comparing the clinical outcomes between the healed groups and the non-healed groups after RSA.
Results: For functional outcomes, the results showed that the healed group had better Constant scores (CSs) (p < 0.0001). For ROM, the healed group showed better flexion (p < 0.0001), abduction (p = 0.02), and external rotation (p < 0.00001) of shoulder. For the design of prosthesis, the mean healing rate of greater tuberosity (82.7%) in patients with fracture-dedicated prosthesis was higher than those (63.0%) in patients with standard prosthesis. Subgroup analyses showed that the CS (p = 0.12) and abduction (p = 0.96) of patients using fracture-dedicated prostheses were not different between the healed groups and the non-healed groups. Meta-regression showed that there was no significant relationship between the design of prosthesis and CS (p = 0.312), flexion (p = 0.422), or external rotation (p = 0.776).
Conclusion: Our meta-analysis showed that the healed groups could obtain better functional outcomes and ROM than the non-healed groups. In addition, fracture-dedicated prostheses promoted the healing rate of greater tuberosity.
Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020157276, PROSPERO: CRD42020157276.

引言：反向肩关节置换术（Reverse shoulder arthroplasty, RSA）在复杂性肱骨近端骨折（proximal humeral fractures, PHFs）的临床治疗中应用愈发普及。大结节愈合情况可对反向肩关节置换术后肩关节的功能结局与活动度（range of motion, ROM）产生影响。此外，假体（prosthesis）的设计同样会对大结节的愈合率产生影响。本研究旨在明确两个核心问题：（1）大结节愈合是否会影响肩关节的功能结局与活动度？（2）假体设计是否会影响大结节的愈合率？
材料与方法：检索PubMed、Ovid/Embase以及Cochrane图书馆，筛选对比反向肩关节置换术后大结节愈合组与未愈合组临床结局的相关研究。
结果：在功能结局方面，愈合组的康纳德评分（Constant scores, CSs）更优（p < 0.0001）。在活动度方面，愈合组的肩关节前屈（p < 0.0001）、外展（p = 0.02）及外旋（p < 0.00001）表现均更佳。针对假体设计的分析显示，使用骨折专用假体（fracture-dedicated prosthesis）患者的大结节平均愈合率（82.7%）高于使用标准假体（standard prosthesis）的患者（63.0%）。亚组分析（subgroup analyses）结果表明，使用骨折专用假体的患者中，愈合组与未愈合组的康纳德评分（p = 0.12）及外展活动度（p = 0.96）并无显著差异。Meta回归分析（Meta-regression）显示，假体设计与康纳德评分（p = 0.312）、前屈活动度（p = 0.422）及外旋活动度（p = 0.776）均无显著相关性。
结论：本项Meta分析（Meta-analysis）结果显示，大结节愈合组的肩关节功能结局与活动度均优于未愈合组。此外，骨折专用假体可提升大结节的愈合率。
系统评价注册：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020157276，PROSPERO注册号：CRD42020157276。