Wolf Jennifer Moriatis, Delaronde Steven
Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030-4037, USA.
J Hand Surg Am. 2012 Jan;37(1):77-82. doi: 10.1016/j.jhsa.2011.10.010. Epub 2011 Nov 25.
Multiple procedures have been described for trapeziometacarpal (TM) osteoarthritis with varying levels of evidence support. The purpose of this study was to evaluate current trends in the treatment of TM arthritis by surveying active members of the American Society for Surgery of the Hand.
We sent an online questionnaire to the e-mail addresses of 2,326 active members of the American Society for Surgery of the Hand, consisting of 5 treatment and 2 demographic questions. Surgeons were contacted twice by e-mail and provided with a link to a de-identified online survey. We performed statistical analysis of correlations between demographics and treatment preferences using chi-square testing.
We received responses from 1,156 out of 2,326 hand surgeons, a response rate of 50%. The vast majority of surgeons use corticosteroid injections for TM arthritis, and 719 out of 1,156 perform trapeziectomy with ligament reconstruction and tendon interposition (LRTI) for common Eaton stage III arthritis. For scaphotrapeziotrapezoid (STT) arthritis, approximately half of respondents also perform trapeziectomy/LRTI, followed by STT fusion. For a younger woman with minimal radiographic change and pain, 535 out of 1,142 surgeon respondents would advocate continued conservative treatment, whereas the remainder chose Eaton ligament reconstruction, arthroscopy, and metacarpal osteotomy.
This survey study presents the current opinions of a group of hand surgeons who responded to an online questionnaire regarding treatment of TM arthritis. The results show that trapeziectomy/LRTI is the treatment of choice by most respondents. The use of trapeziectomy/LRTI in the treatment of STT arthritis has not been studied in depth, but this procedure was chosen by half the respondents. The process of choosing treatment strategies is a question for future study.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
针对大多角骨-第一掌骨（TM）骨关节炎，已有多种治疗方法被描述，且证据支持程度各异。本研究旨在通过对美国手外科协会的活跃会员进行调查，评估TM关节炎治疗的当前趋势。
我们向美国手外科协会2326名活跃会员的电子邮箱发送了一份在线问卷，其中包含5个治疗相关问题和2个人口统计学问题。通过电子邮件与外科医生联系了两次，并提供了一个去识别化的在线调查链接。我们使用卡方检验对人口统计学和治疗偏好之间的相关性进行了统计分析。
我们收到了2326名手外科医生中1156人的回复，回复率为50%。绝大多数外科医生使用皮质类固醇注射治疗TM关节炎，在1156名医生中，有719人对常见的伊顿III期关节炎进行大多角骨切除术并韧带重建及肌腱植入（LRTI）。对于舟大多角小多角（STT）关节炎，约一半的受访者也进行大多角骨切除术/LRTI，其次是STT融合术。对于一名影像学改变和疼痛轻微的年轻女性，在1142名参与回复的外科医生中，有535人会主张继续保守治疗，而其余的人则选择伊顿韧带重建、关节镜检查和掌骨截骨术。
这项调查研究展示了一组手外科医生对一份关于TM关节炎治疗的在线问卷的当前看法。结果表明，大多角骨切除术/LRTI是大多数受访者的首选治疗方法。大多角骨切除术/LRTI在STT关节炎治疗中的应用尚未得到深入研究，但有一半的受访者选择了该手术。选择治疗策略的过程是未来研究的一个问题。
研究类型/证据水平：预后性IV级。
