Deans Victoria M, Naqui Zafar, Muir Lindsay T S W
1 Department of Hand Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK.
J Hand Surg Asian Pac Vol. 2017 Mar;22(1):1-9. doi: 10.1142/S0218810417300017.
The management of scaphotrapeziotrapezoidal (STT) joint osteoarthritis (OA) remains controversial. This systematic review aims to review the evidence for surgical interventions specific to STT OA.
Medline and Embase libraries were searched using a pre-defined search strategy in October 2014. All study designs and languages were included and evaluated by two reviewers (VMD and LM) against the inclusion/exclusion criteria. The study eligibility criteria included papers discussing surgical treatment of STT OA, and the review was conducted using the PRISMA guidelines.
295 unique results were identified from the search strategy after duplicates were filtered. 21 articles met the eligibility criteria.
Trapezial excision and partial trapezoidal excision is an effective treatment with low morbidity and complications, although can lead to weakness of the thumb. Distal scaphoid excision remains an effective pain relief treatment with improved grip and pinch strengths post-operatively. The procedure is technically less demanding than arthrodesis, does not carry the risks of non-union and complication rate of STT joint arthrodesis, and has a shorter immobilisation requirement. It produces reliable results, but is contraindicated if there is either scapholunocapitate pathology or midcarpal instability. STT joint fusion has a place, typically producing 75% range of movement of the non-operated wrist. However it has a higher associated complication rate, and simultaneous radial styloidectomy is recommended to reduce ongoing pain from impingement. Implant arthroplasty using a graphite-coated pyrocarbon implant has been used more recently. The patients gained significant pain relief, although there have been reports of implant dislocation secondary to surgical errors. A reduction in post-operative wrist extension and radial deviation has been noted. From this systematic review, we have composed a treatment algorithm for the surgical management of STT joint OA.
舟大多角小多角（STT）关节骨关节炎（OA）的治疗仍存在争议。本系统评价旨在综述针对STT OA的手术干预证据。
2014年10月使用预定义检索策略对Medline和Embase数据库进行检索。纳入所有研究设计和语言，并由两名评价者（VMD和LM）根据纳入/排除标准进行评估。研究纳入标准包括讨论STT OA手术治疗的论文，并使用PRISMA指南进行综述。
在筛选重复项后，检索策略共识别出295个独特结果。21篇文章符合纳入标准。
大多角骨切除和部分小多角骨切除是一种有效的治疗方法，发病率和并发症较低，尽管可能导致拇指无力。舟骨远端切除仍然是一种有效的缓解疼痛的治疗方法，术后握力和捏力有所改善。该手术在技术上比关节融合要求低，不具有骨不连风险和STT关节融合的并发症发生率，固定要求也较短。它产生可靠的结果，但如果存在舟月头状骨病变或腕中关节不稳则为禁忌。STT关节融合有其应用价值，通常可使未手术侧腕关节活动度达到75%。然而，其相关并发症发生率较高，建议同时行桡骨茎突切除术以减轻撞击引起的持续疼痛。最近开始使用石墨涂层热解碳植入物进行植入关节成形术。患者疼痛得到显著缓解，尽管有因手术失误导致植入物脱位的报道。术后腕关节伸展和桡偏减少。通过本系统评价，我们制定了STT关节OA手术治疗的算法。
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