Day Charles S, Gelberman Richard, Patel Alpesh A, Vogt Molly T, Ditsios Konstantinos, Boyer Martin I
Department of Orthopaedic Surgery, Washington University at Barnes-Jewish Hospital, One Barnes Hospital Plaza, St Louis, MO 63110, USA.
J Hand Surg Am. 2004 Mar;29(2):247-51. doi: 10.1016/j.jhsa.2003.12.002.
There have been few prospective studies evaluating the results of nonsurgical treatment of a well-defined patient cohort with symptomatic basal joint osteoarthritis of the thumb. This prospective study uses a validated outcome instrument to examine the effectiveness of a single steroid injection and 3 weeks of splinting in patients with osteoarthritis in Eaton stages 1 to 4 with a minimum of 18 months of follow-up evaluation.
Thirty consecutive patients (30 thumbs) were studied prospectively to evaluate the efficacy of a single injection of corticosteroid into the trapeziometacarpal joint, followed by immobilization in a thumb spica splint for 3 weeks. All patients answered an outcome-based questionnaire (Disabilities of the Arm, Shoulder, and Hand) and were examined before injection, 6 weeks after injection, and at final follow-up examination (minimum, 18 months). Eaton radiographic stage was recorded by 3 independent observers.
At 6 weeks 13 patients had improvement in pain intensity and 17 patients reported no symptomatic improvement. Twelve of those with relief at 6 weeks continued to have relief at long term follow-up evaluation (mean, 25 months). Of patients with long-term relief average grip strength of the affected thumb was 95% of contralateral side, whereas those without relief had grip strength values that were 60% of contralateral side. For those patients without relief at 6 weeks there was no improvement seen at later follow-up evaluation. Five patients with Eaton stage 1 disease had an average of 23 months of relief with nonsurgical treatment. In stage 2 and stage 3 disease 7 thumbs improved at 6 weeks after injection and 6 thumbs had long-term relief. In stage 4 disease, 6 thumbs had neither short-term nor long-term relief with the injection. Disease side, handedness, and smoking did not affect outcomes. At final follow-up evaluation 12 thumbs had had surgical treatment.
Steroid injection with splinting for the treatment of basal joint arthritis of the thumb provided reliable long-term relief in thumbs with Eaton stage 1 disease but provided long-term relief in only 7 of 17 thumbs with Eaton stage 2 and stage 3 basal joint arthritis.
很少有前瞻性研究评估对明确界定的有症状的拇指基底关节骨关节炎患者队列进行非手术治疗的结果。这项前瞻性研究使用经过验证的结果评估工具，以检查单次类固醇注射和3周夹板固定对伊顿（Eaton）1至4期骨关节炎患者的有效性，并进行至少18个月的随访评估。
对30例连续患者（30个拇指）进行前瞻性研究，以评估向大多角骨掌骨关节单次注射皮质类固醇，随后用拇指人字形夹板固定3周的疗效。所有患者均回答了基于结果的问卷（手臂、肩部和手部功能障碍），并在注射前、注射后6周以及最终随访检查（至少18个月）时接受检查。伊顿放射学分期由3名独立观察者记录。
在6周时，13例患者疼痛强度有所改善，17例患者报告症状无改善。在6周时缓解的患者中有12例在长期随访评估（平均25个月）中持续缓解。在长期缓解的患者中，患侧拇指的平均握力为对侧的95%，而未缓解的患者握力值为对侧的60%。对于那些在6周时未缓解的患者，在后期随访评估中未见改善。5例伊顿1期疾病患者经非手术治疗平均缓解23个月。在2期和3期疾病中，7个拇指在注射后6周有所改善，6个拇指长期缓解。在4期疾病中，6个拇指注射后既无短期缓解也无长期缓解。疾病侧别、利手和吸烟均不影响结果。在最终随访评估时，12个拇指接受了手术治疗。
类固醇注射联合夹板固定治疗拇指基底关节关节炎，可为伊顿1期疾病的拇指提供可靠的长期缓解，但在17个伊顿2期和3期拇指基底关节关节炎中，只有7个能获得长期缓解。
