Aujla R S, Sheikh N, Divall P, Bhowal B, Dias J J
University Hospitals of Leicester, Leicester LE1 5WW, UK.
Bone Joint J. 2017 Jan;99-B(1):100-106. doi: 10.1302/0301-620X.99B1.37237.
We performed a systematic review of the current literature regarding the outcomes of unconstrained metacarpophalangeal joint (MCPJ) arthroplasty.
We initially identified 1305 studies, and 406 were found to be duplicates. After exclusion criteria were applied, seven studies were included. Outcomes extracted included pre- and post-operative pain visual analogue scores, range of movement (ROM), strength of pinch and grip, satisfaction and patient reported outcome measures (PROMs). Clinical and radiological complications were recorded. The results are presented in three groups based on the design of the arthroplasty and the aetiology (pyrocarbon-osteoarthritis (pyro-OA), pyrocarbon-inflammatory arthritis (pyro-IA), metal-on-polyethylene (MoP)).
Results show that pyrocarbon implants provide an 85% reduction in pain, 144% increase of pinch grip and 13° improvements in ROM for both OA and IA combined. Patients receiving MoP arthroplasties had a reduction in pinch strength. Satisfaction rates were 91% and 92% for pyrocarbon-OA and pyrocarbon-IA groups, respectively. There were nine failures in 87 joints (10.3%) over a mean follow-up of 5.5 years (1.0 to 14.3) for pyro-OA. There were 18 failures in 149 joints (12.1%) over a mean period of 6.6 years (1.0 to 16.0) for pyro-IA. Meta-analysis was not possible due to the heterogeneity of the studies and the limited presentation of data.
We would recommend prospective data collection for small joint arthroplasties of the hand consisting of PROMs that would allow clinicians to come to stronger conclusions about the impact on function of replacing the MCPJs. A national joint registry may be the best way to achieve this. Cite this article: Bone Joint J 2017;99-B:100-6.
我们对目前有关非约束性掌指关节（MCPJ）置换术结果的文献进行了系统评价。
我们最初识别出1305项研究，发现其中406项为重复研究。应用排除标准后，纳入了7项研究。提取的结果包括术前和术后疼痛视觉模拟评分、活动范围（ROM）、捏力和握力、满意度以及患者报告的结局指标（PROMs）。记录临床和放射学并发症。根据关节置换术的设计和病因（热解碳-骨关节炎（pyro-OA）、热解碳-炎性关节炎（pyro-IA）、金属对聚乙烯（MoP））将结果分为三组呈现。
结果显示，对于骨关节炎（OA）和炎性关节炎（IA）合并病例，热解碳植入物可使疼痛减轻85%，捏力增加144%，ROM改善13°。接受MoP关节置换术的患者捏力有所下降。热解碳-OA组和热解碳-IA组的满意度分别为91%和92%。热解碳-骨关节炎组在平均5.5年（1.0至14.3年）的随访期内，87个关节中有9个失败（10.3%）。热解碳-炎性关节炎组在平均6.6年（1.0至16.0年）的时间内，149个关节中有18个失败（12.1%）。由于研究的异质性和数据呈现有限，无法进行荟萃分析。
我们建议对手部小关节置换术进行前瞻性数据收集，收集内容包括患者报告的结局指标，这将使临床医生能够就替换MCPJ对功能的影响得出更有力的结论。国家关节注册系统可能是实现这一目标的最佳途径。引用本文：《骨与关节杂志》2017年；99-B：100 - 6。
