本文由小咖机器人翻译整理

期刊来源：BMJ

原文链接：https://doi.org/10.1136/bmj-2023-077939

摘要内容如下：

目标

通过比较因骨关节炎而接受选择性初次肩关节置换术的患者中与逆向全肩关节置换术（RTSR）和解剖性全肩关节置换术（TSR）相关的风险-效益和成本，回答国家研究重点。

设计

基于人群的队列研究，使用英国国家联合登记和医院事件统计数据。

设置

英格兰公立医院和私立医院的公共资助程序，2012-20。

参与者

因肩袖肌腱完整的骨关节炎而接受RTSR或TSR的60岁或以上的成年人。患者是从国家联合登记处确定的，并与NHS医院事件统计和民事登记死亡率数据相关联。使用倾向评分匹配和治疗加权的逆概率来平衡研究组。

主要结果指标

主要结果指标是翻修手术。次要结果指标包括90天内的严重不良事件、12个月内的再次手术、住院时间延长（超过3个晚上）、牛津肩评分的变化（术前至术后6个月）以及医疗保健服务的终身成本。

结果

倾向评分匹配人群包括7124例RTSR或TSR手术（126例已修订），治疗加权逆概率人群包括12968例手术（294例已修订），最长随访时间为8.75年。RTSR前三年翻修的风险比降低（风险比局部最小值0.33，95%置信区间0.18至0.59），无翻修限制的平均生存时间无临床重要差异，12个月时再次手术的相对风险降低（比值比0.45，95%置信区间0.25至0.83），绝对风险差异为-0.51%（95%置信区间-0.89至-0.13）。严重不良事件和住院时间延长的风险、牛津肩评分的变化以及模拟的平均终生成本相似。加权后结果保持一致。

结论

这项研究的结果再次证明，对于60岁或以上的骨关节炎和完整的肩袖肌腱患者，RTSR是一种可接受的替代TSR的方法。尽管随着时间的推移，翻修手术的风险状况存在显著差异，但在长期翻修手术、严重不良事件、再次手术、住院时间延长或终生医疗保健费用方面，未发现RTSR和TSR之间具有统计学意义和临床意义的差异。

英文原文如下：

Abstracts

OBJECTIVES  To answer a national research priority by comparing the risk-benefit and costs associated with reverse total shoulder replacement (RTSR) and anatomical total shoulder replacement (TSR) in patients having elective primary shoulder replacement for osteoarthritis.

DESIGN  Population based cohort study using data from the National Joint Registry and Hospital Episode Statistics for England.

SETTING  Public hospitals and publicly funded procedures at private hospitals in England, 2012-20.

PARTICIPANTS  Adults aged 60 years or older who underwent RTSR or TSR for osteoarthritis with intact rotator cuff tendons. Patients were identified from the National Joint Registry and linked to NHS Hospital Episode Statistics and civil registration mortality data. Propensity score matching and inverse probability of treatment weighting were used to balance the study groups.

MAIN OUTCOME MEASURES  The main outcome measure was revision surgery. Secondary outcome measures included serious adverse events within 90 days, reoperations within 12 months, prolonged hospital stay (more than three nights), change in Oxford Shoulder Score (preoperative to six month postoperative), and lifetime costs to the healthcare service.

RESULTS  The propensity score matched population comprised 7124 RTSR or TSR procedures (126 were revised), and the inverse probability of treatment weighted population comprised 12 968 procedures (294 were revised) with a maximum follow-up of 8.75 years. RTSR had a reduced hazard ratio of revision in the first three years (hazard ratio local minimum 0.33, 95% confidence interval 0.18 to 0.59) with no clinically important difference in revision-free restricted mean survival time, and a reduced relative risk of reoperations at 12 months (odds ratio 0.45, 95% confidence interval 0.25 to 0.83) with an absolute risk difference of -0.51% (95% confidence interval -0.89 to -0.13). Serious adverse events and prolonged hospital stay risks, change in Oxford Shoulder Score, and modelled mean lifetime costs were similar. Outcomes remained consistent after weighting.

CONCLUSIONS  This study's findings provide reassurance that RTSR is an acceptable alternative to TSR for patients aged 60 years or older with osteoarthritis and intact rotator cuff tendons. Despite a significant difference in the risk profiles of revision surgery over time, no statistically significant and clinically important differences between RTSR and TSR were found in terms of long term revision surgery, serious adverse events, reoperations, prolonged hospital stay, or lifetime healthcare costs.

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