一项旨在确定晚期拇指腕掌关节骨关节炎手术治疗当前实践模式的调查。
A survey to determine current practice patterns in the surgical treatment of advanced thumb carpometacarpal osteoarthrosis.
作者信息
Brunton Lance M, Wilgis E F Shaw
机构信息
The Curtis National Hand Center, Union Memorial Hospital, 3333 North Calvert Street, Suite M60, Baltimore, MD 21218 USA.
出版信息
Hand (N Y). 2010 Dec;5(4):415-22. doi: 10.1007/s11552-010-9275-7. Epub 2010 Jun 3.
BACKGROUND
The purpose of this study was to determine current practice patterns and examine the influence of recent evidence in the surgical treatment of advanced thumb carpometacarpal (CMC) osteoarthrosis.
METHODS
A survey was sent to 2,536 American Society for Surgery of the Hand members. Information regarding specialty training, years of experience, annual cases performed, treatment of choice, technique, and postoperative immobilization was collected. Respondents were asked whether their current treatment of choice differs from what they performed 5 years ago and about the importance of ligament reconstruction and "interposition" to thumb CMC arthroplasty success.
RESULTS
One thousand twenty-four respondents completed the survey (40% response rate). Treatment of choice was trapeziectomy with ligament reconstruction and tendon interposition (68%), regardless of specialty training, years of experience, and annual cases performed. Over 70% favored treatment that was not different from what they performed 5 years ago. Less than 3% of respondents perform a trapeziectomy alone; only 14 surgeons have changed to this procedure in the last 5 years. Only 35% of the 822 respondents who perform a ligament reconstruction and 14% of the 764 respondents who perform an interposition believe those techniques are "extremely important" to thumb CMC arthroplasty success.
CONCLUSIONS
Despite recent evidence that suggests neither ligament reconstruction nor tendon interposition confers any additional benefit over trapeziectomy alone, few respondents have converted to the simpler procedure. Either the current evidence is not convincing enough to drastically change practice patterns, or other factors apart from this evidence have a greater influence on surgical decision-making for advanced thumb CMC osteoarthrosis.
ELECTRONIC SUPPLEMENTARY MATERIAL
The online version of this article (doi:10.1007/s11552-010-9275-7) contains supplementary material, which is available to authorized users.
背景
本研究旨在确定当前的治疗模式，并探讨近期证据对晚期拇指腕掌关节（CMC）骨关节炎手术治疗的影响。
方法
向2536名美国手外科协会成员发送了一份调查问卷。收集了有关专业培训、经验年限、每年手术病例数、治疗选择、技术以及术后固定的信息。受访者被问及他们当前的治疗选择是否与5年前不同，以及韧带重建和“植入”对拇指CMC关节成形术成功的重要性。
结果
1024名受访者完成了调查（回复率为40%）。无论专业培训、经验年限和每年手术病例数如何，治疗选择均为带韧带重建和肌腱植入的大多角骨切除术（68%）。超过70%的人倾向于与5年前相同的治疗方法。不到3%的受访者仅进行大多角骨切除术；在过去5年中，只有14名外科医生改为这种手术方式。在822名进行韧带重建的受访者中，只有35%，在764名进行植入手术的受访者中，只有14%认为这些技术对拇指CMC关节成形术的成功“极其重要”。
结论
尽管近期有证据表明韧带重建和肌腱植入相比单纯的大多角骨切除术并无额外益处，但很少有受访者改用更简单的手术方式。要么是当前证据不足以彻底改变治疗模式，要么是除该证据之外的其他因素对晚期拇指CMC骨关节炎的手术决策有更大影响。
电子补充材料
本文的在线版本（doi:10.1007/s11552-010-9275-7）包含补充材料，授权用户可获取。
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