Vermeulen Guus M, Slijper Harm, Feitz Reinier, Hovius Steven E R, Moojen Thybout M, Selles Ruud W
Department of Hand and Wrist Surgery, Diakonessenhuis Zeist, Rotterdam, The Netherlands.
J Hand Surg Am. 2011 Jan;36(1):157-69. doi: 10.1016/j.jhsa.2010.10.028.
The aim of this article is to provide an updated systematic review on the 8 most commonly used surgical procedures to treat trapeziometacarpal osteoarthritis. A thorough literature search was performed using predetermined criteria. A total of 35 articles fulfilled the inclusion criteria. Nine of these 35 articles were not included in previous systematic reviews. Systematic evaluation demonstrated the following: (1) there is no evidence that trapeziectomy or trapeziectomy with tendon interposition is superior to any of the other techniques. However, when interposition is performed, autologous tissue interposition seems to be preferable. (2) Trapeziectomy with ligament reconstruction or trapeziectomy with ligament reconstruction and tendon interposition (LRTI) is not superior to any of the other techniques. However, follow-up in the studies with a higher level of evidence was relatively short (12 mo); therefore, long-term benefits could not be assessed. In addition, trapeziectomy with LRTI seems associated with a higher complication rate. (3) Because the studies on thumb carpometacarpal (CMC) arthrodesis were of less methodological quality and had inconsistent outcomes, we are not able to conclude whether CMC arthrodesis is superior to any other technique. Therefore, high-level randomized trials comparing CMC arthrodesis with other procedures are needed. Nevertheless, findings in the newly included studies did show that nonunion rates in the literature are on average 8% to 21% and, complications and repeat surgeries are more frequent following CMC arthrodesis. (4) A study on joint replacement showed that total joint prosthesis might have better short-term results compared to trapeziectomy with LRTI. However, high-level randomized trials comparing total joint prosthesis with other procedures are needed. In addition, there is no evidence that the Artelon spacer is superior to trapeziectomy with LRTI. We conclude that, at this time, no surgical procedure is proven to be superior to another. However, based on good results of CMC arthrodesis and total joint prostheses, we postulate that there could be differences between the various surgical procedures. Therefore randomized clinical trials of CMC arthrodesis and total joint prostheses compared to trapeziectomy with long follow-up (>1 y) are warranted.
本文旨在对治疗大多角骨-第一掌骨骨关节炎的8种最常用外科手术进行最新的系统评价。采用预定标准进行了全面的文献检索。共有35篇文章符合纳入标准。这35篇文章中有9篇未被纳入先前的系统评价。系统评价表明：（1）没有证据表明大多角骨切除术或带肌腱植入的大多角骨切除术优于其他任何技术。然而，当进行植入时，自体组织植入似乎更可取。（2）带韧带重建的大多角骨切除术或带韧带重建及肌腱植入的大多角骨切除术（LRTI）并不优于其他任何技术。然而，证据水平较高的研究随访时间相对较短（12个月）；因此，无法评估其长期益处。此外，带LRTI的大多角骨切除术似乎并发症发生率更高。（3）由于关于拇指腕掌（CMC）关节融合术的研究方法学质量较低且结果不一致，我们无法得出CMC关节融合术是否优于其他任何技术的结论。因此，需要进行将CMC关节融合术与其他手术进行比较的高水平随机试验。尽管如此，新纳入研究的结果确实表明，文献中的不愈合率平均为8%至21%，并且CMC关节融合术后并发症和再次手术更为常见。（4）一项关于关节置换的研究表明，与带LRTI的大多角骨切除术相比，全关节假体可能有更好的短期效果。然而，需要进行将全关节假体与其他手术进行比较的高水平随机试验。此外，没有证据表明Artelon间隔物优于带LRTI的大多角骨切除术。我们得出结论，目前没有一种外科手术被证明优于另一种。然而，基于CMC关节融合术和全关节假体的良好效果，我们推测各种外科手术之间可能存在差异。因此，有必要进行将CMC关节融合术和全关节假体与带LRTI的大多角骨切除术进行比较的随机临床试验，并进行长期随访（>1年）。
