Ozkan Berna, Keskin Dilek, Bodur Hatice, Barça Nurdan
Physical Medicine and Rehabilitation Department, Numune Training and Research Hospital, Talatpaşa Caddesi, Samanpazari, 06100 Ankara, Turkey.
Clin Rheumatol. 2007 Oct;26(10):1621-5. doi: 10.1007/s10067-007-0555-8. Epub 2007 Feb 24.
The aim of the study was to investigate the effect of osteoarthritis (OA) on hand function in elderly patients. One hundred elderly patients with a mean age of 68.50 +/- 6.37 years (87 women, 13 men) were enrolled to the study. Radiological hand OA was defined as the presence of Kellgren-Lawrence (K-L) grade > or = 2. Grip strength, and lateral, tip, and three-fingered pinches were measured. Hand function was assessed by Dreiser's functional index. Subjective hand disability was assessed by the hand disability index of Stanford Health Assessment Questionnaire (HAQ) and by self-reported functional limitation. Coordination was evaluated by testing for rapid alternating movement (RAM) and fine finger movement (FFM). The Jebsen test of hand function was used to determine functional hand use. Forty patients had K-L > or = 2 radiological hand OA, and 60 patients had K-L = 0 and 1 and were accepted as the control group. In the clinical examination, 54 patients had Heberden's nodules and 35 had Bouchard's nodules. Self-reported functional limitation tests (activities like carrying a bundle and handling or fingering small objects) were significantly worse in patients with radiographic hand OA, and also, non-dominant hand RAM was slower in the same group. According to the evaluation of the radiologic grades of OA, grades 3-4 OA had higher scores than the control and grade 2 OA group. Our results suggest that there is a lack of association between radiological hand OA and Jebsen test and objective hand functions like grip and pinch strength, but the patients with radiological hand OA have restrictions in the self-reported functional limitation test. The presence of tenderness, pain, and Heberden's and Bouchard's nodules had a negative effect on hand functions. Dreiser's functional index and the hand disability index of HAQ were found as related parameters with the radiological grade of OA.
本研究的目的是调查骨关节炎（OA）对老年患者手部功能的影响。100名平均年龄为68.50±6.37岁的老年患者（87名女性，13名男性）被纳入本研究。手部放射学OA被定义为存在Kellgren-Lawrence（K-L）分级≥2级。测量握力、侧捏力、指尖捏力和三指捏力。采用Dreiser功能指数评估手部功能。通过斯坦福健康评估问卷（HAQ）的手部残疾指数和自我报告的功能受限情况评估主观手部残疾。通过快速交替运动（RAM）测试和精细手指运动（FFM）评估协调性。使用Jebsen手部功能测试来确定手部功能的实际使用情况。40名患者手部放射学K-L分级≥2级，60名患者K-L分级为0级和1级，被纳入对照组。在临床检查中，54名患者有赫伯登结节，35名患者有布夏尔结节。手部放射学OA患者自我报告的功能受限测试（如搬运包裹和处理或操作小物体等活动）明显更差，并且同一组中非优势手的RAM也较慢。根据OA放射学分级评估，3 - 4级OA组的得分高于对照组和2级OA组。我们的结果表明，手部放射学OA与Jebsen测试以及握力和捏力等客观手部功能之间缺乏关联，但手部放射学OA患者在自我报告的功能受限测试中存在限制。压痛、疼痛以及赫伯登结节和布夏尔结节的存在对手部功能有负面影响。发现Dreiser功能指数和HAQ的手部残疾指数与OA的放射学分级相关。
