Yuan Frank, Aliu Oluseyi, Chung Kevin C, Mahmoudi Elham
Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI.
J Hand Surg Am. 2017 Feb;42(2):104-112.e1. doi: 10.1016/j.jhsa.2016.11.029.
Thumb carpometacarpal (CMC) arthritis contributes considerably to functional disability in the aging adult United States (US) population. Owing to the increasing growth in this segment of our population, its burden on health care resources will increase in the future. Variations exist in the degree of complexity and cost among different surgical treatments. We examined the national trends of the surgical treatment of thumb CMC arthritis and hypothesized that current practice patterns are not supported by evidence favoring the simpler trapeziectomy-only procedure.
Using a random 5%, nationally representative, sample of Medicare fee-for-service beneficiaries diagnosed with thumb CMC arthritis between 2001 and 2010, we used a multinomial logistic regression model to assess the association between patients' characteristics and the surgical treatment. Furthermore, we used surgeons' unique identifiers to examine how their practice preferences have changed over time.
Our findings demonstrated an increasing trend in the utilization of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) from 84% in 2001 to 90% in 2010. Ninety-five percent of surgeons performed only 1 type of surgical procedure, and among those, 93% of surgeons performed only trapeziectomy with LRTI. Compared with 2001, the odds of a patient undergoing thumb CMC arthrodesis or prosthetic arthroplasty slightly increased between 2007 and 2010.
The majority of hand surgeons in the US use trapeziectomy with LRTI as the surgical treatment of choice for thumb CMC arthritis. Although clinical trials from the United Kingdom support the use of the less complex trapeziectomy-only procedure, US surgeons are still reticent to change their practice, which favors LRTI. National comparative studies are still needed to examine the effectiveness of various surgical options for the treatment of thumb CMC joint arthritis.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
拇指腕掌关节（CMC）关节炎在老龄化的美国人群中导致了相当严重的功能残疾。由于该人群这一细分部分的不断增长，其对医疗资源的负担在未来将会增加。不同手术治疗在复杂程度和成本上存在差异。我们研究了拇指CMC关节炎手术治疗的全国趋势，并假设当前的实践模式并未得到支持采用仅单纯大多角骨切除术这种更简单手术的证据的支持。
我们使用了2001年至2010年间被诊断为拇指CMC关节炎的医疗保险按服务付费受益人的5%随机全国代表性样本，采用多项逻辑回归模型来评估患者特征与手术治疗之间的关联。此外，我们使用外科医生的唯一标识符来研究他们的实践偏好随时间的变化情况。
我们的研究结果显示，从2001年的84%到2010年，大多角骨切除联合韧带重建和肌腱植入（LRTI）的使用率呈上升趋势。95%的外科医生仅进行1种手术，其中93%的外科医生仅进行大多角骨切除联合LRTI。与2001年相比，2007年至2010年间患者接受拇指CMC关节融合术或人工关节置换术的几率略有增加。
美国大多数手外科医生将大多角骨切除联合LRTI作为拇指CMC关节炎的首选手术治疗方法。尽管来自英国的临床试验支持使用更简单的仅单纯大多角骨切除术，但美国外科医生仍不愿改变他们倾向于LRTI的做法。仍需要进行全国性的比较研究来检验各种手术方案治疗拇指CMC关节关节炎的有效性。
研究类型/证据水平：预后性研究II级
