Wajon Anne, Carr Emma, Edmunds Ian, Ada Louise
Hand Therapy at Hornsby, 2/49 Palmerston Rd, Hornsby, New South Wales, Australia, 2077.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD004631. doi: 10.1002/14651858.CD004631.pub3.
This is an update of a Cochrane Review first published in 2005. Surgery has been used to treat persistent pain and dysfunction at the base of the thumb. However, there is no evidence to suggest that any one surgical procedure is superior to another.
To compare the effect of different surgical techniques in reducing pain and improving physical function, patient global assessment, range of motion and strength in people with trapeziometacarpal osteoarthritis at 12 months. Additionally, to investigate whether there was any improvement or deterioration in outcomes between the 12-month review and five year follow up.
We searched:(CENTRAL) (The Cochrane Library 2008, issue 1), MEDLINE (1950 to Dec 2008), CINAHL (1982 to Dec 2008), AMED (1985 to Dec 2008) and EMBASE (1974 to Dec 2008), and performed handsearching of conference proceedings and reference lists from reviews and papers.
Randomised or quasi-randomised trials where the intervention was surgery and pain, physical function, patient global assessment, range of motion or strength was measured as an outcome.
Two review authors independently selected studies according to the inclusion criteria, assessed the risk of bias and extracted data, including adverse effects. We contacted trial authors for missing information.
We included nine studies involving 477 participants. Seven surgical procedures were identified (trapeziectomy with ligament reconstruction and tendon interposition (LRTI), trapeziectomy, trapeziectomy with ligament reconstruction, trapeziectomy with interpositional arthroplasty, Artelon joint resurfacing, arthrodesis and joint replacement). Studies reported results of a mixed group of participants with Stage II-IV osteoarthritis, with a range of improvement for pain and physical function. The majority of studies included in this review had an unclear risk of bias which raises some doubt about the results. No procedure demonstrated any superiority over another in terms of pain, physical function, patient global assessment or range of motion. Of participants who underwent trapeziectomy with ligament reconstruction and tendon interposition, 22% had adverse effects (including scar tenderness, tendon adhesion or rupture, sensory change, or Complex Regional Pain Syndrome (Type 1)) compared to 10% who underwent trapeziectomy. Trapeziectomy with ligament reconstruction and tendon interposition is therefore associated with 12% more adverse effects (RR = 2.21, 95% CI 1.18 to 4.15).
AUTHORS' CONCLUSIONS: Although it appears that no one procedure produces greater benefit in terms of pain and physical function, there was insufficient evidence to be conclusive. Trapeziectomy has fewer complications than trapeziectomy with LRTI.
这是对2005年首次发表的Cochrane系统评价的更新。手术已被用于治疗拇指基部的持续性疼痛和功能障碍。然而，没有证据表明任何一种手术方法优于另一种。
比较不同手术技术在12个月时减轻疼痛、改善身体功能、患者整体评估、活动范围和力量方面的效果。此外，调查在12个月的评价和五年随访之间结果是否有任何改善或恶化。
我们检索了：（CENTRAL）（《Cochrane图书馆》2008年第1期）、MEDLINE（1950年至2008年12月）、CINAHL（1982年至2008年12月）、AMED（1985年至2008年12月）和EMBASE（1974年至2008年12月），并对手稿进行手工检索，包括会议论文集以及综述和论文的参考文献列表。
干预措施为手术且将疼痛、身体功能、患者整体评估、活动范围或力量作为结局指标进行测量的随机或半随机试验。
两名综述作者根据纳入标准独立选择研究，评估偏倚风险并提取数据，包括不良反应。我们联系试验作者获取缺失信息。
我们纳入了9项研究，涉及477名参与者。确定了7种手术方法（带韧带重建和肌腱植入的大多角骨切除术（LRTI）、大多角骨切除术、带韧带重建的大多角骨切除术、带间置关节成形术的大多角骨切除术、Artelon关节表面置换术、关节融合术和关节置换术）。研究报告了II-IV期骨关节炎混合参与者组的结果，疼痛和身体功能有不同程度的改善。本综述纳入的大多数研究偏倚风险不明确，这对结果提出了一些疑问。在疼痛、身体功能、患者整体评估或活动范围方面，没有任何一种手术方法显示出优于其他方法。接受带韧带重建和肌腱植入的大多角骨切除术的参与者中，22%有不良反应（包括瘢痕压痛、肌腱粘连或断裂、感觉改变或复杂性区域疼痛综合征（1型）），而接受大多角骨切除术的参与者中这一比例为10%。因此，带韧带重建和肌腱植入的大多角骨切除术的不良反应多12%（RR = 2.21，95%CI 1.18至4.15）。
尽管似乎没有一种手术方法在疼痛和身体功能方面能产生更大益处，但证据不足，无法得出定论。大多角骨切除术的并发症比带LRTI的大多角骨切除术少。
