Lozano-Calderon Santiago A, Souer J Sebastiaan, Jupiter Jesse B, Ring David
Orthopaedic Hand and Upper Extremity Service, Yawkey Center For Outpatient Care, Department of Orthopedic Surgery, Harvard Medical School, Massachusetts General Hospital, Yawkey Center Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA.
Hand (N Y). 2008 Sep;3(3):271-5. doi: 10.1007/s11552-008-9098-y. Epub 2008 Mar 29.
Among 44 consecutive patients electing operative treatment of trapeziometacarpal arthrosis, three age- and gender-matched controls that presented during the same time period but had not yet requested operative treatment were selected from billing records. Each patient and control was mailed a survey that included an upper extremity-specific health status measure (Disabilities of the Arm, Shoulder, and Hand questionnaire; DASH) and a set of questionnaires evaluating psychological factors including the Pain Anxiety Symptoms Scale (PASS), the Pain Catastrophizing Scale (PCS) and the Center for the Epidemiological Study of Depression (CES-D) instrument. Seventy-two patients (45%; 31 that elected operative and 41 nonoperative care) returned a completed questionnaire with usable data. Older age was the only significant predictor of choice for nonoperative treatment among survey responders. Arm-specific disability (DASH) correlated with the CES-D, PASS, and PCS scores, and the influence of radiographic severity was near significant (p = 0.06). Stepwise multiple linear regression resulted in a model including the CES-D and PCS scores and accounting for 51% of the variability in DASH scores for patients from both cohorts. For both the operative and nonoperative cohorts, a model including CES-D alone accounted for 50% of the variability in DASH scores (p < 0.01). This study suggests that depression, pain anxiety, and pain catastrophizing are strong correlates of arm-specific disability but do not predict election of operative treatment in patients with trapeziometacarpal arthrosis.
在44例连续选择手术治疗第一掌腕关节病的患者中，从计费记录中选取了3例年龄和性别匹配的对照，这些对照在同一时期就诊但尚未要求手术治疗。向每位患者和对照邮寄了一份调查问卷，其中包括一项上肢特定的健康状况测量指标（手臂、肩部和手部功能障碍问卷；DASH）以及一组评估心理因素的问卷，包括疼痛焦虑症状量表（PASS）、疼痛灾难化量表（PCS）和流行病学研究中心抑郁量表（CES-D）。72例患者（45%；31例选择手术治疗，41例选择非手术治疗）返回了一份填写完整且有可用数据的问卷。在调查回复者中，年龄较大是选择非手术治疗的唯一显著预测因素。手臂特定功能障碍（DASH）与CES-D、PASS和PCS评分相关，影像学严重程度的影响接近显著（p = 0.06）。逐步多元线性回归得出一个模型，该模型包括CES-D和PCS评分，占两个队列患者DASH评分变异性的51%。对于手术和非手术队列，仅包含CES-D的模型占DASH评分变异性的50%（p < 0.01）。这项研究表明，抑郁、疼痛焦虑和疼痛灾难化与手臂特定功能障碍密切相关，但不能预测第一掌腕关节病患者对手术治疗的选择。
