Wilkens Suzanne C, Bargon Claudia A, Mohamadi Amin, Chen Neal C, Coert J Henk
1 Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
2 Department Plastic Surgery and Hand Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
J Hand Surg Eur Vol. 2018 Dec;43(10):1098-1105. doi: 10.1177/1753193418757122. Epub 2018 Feb 16.
Arthroscopic management of thumb carpometacarpal (CMC) osteoarthrosis (OA) is an approach that has unclear results. We performed a systematic review encompassing three electronic databases up to May 2016 for studies describing arthroscopic-assisted techniques for thumb CMC OA. Meta-analyses of visual analogue scores (VAS) for pain, Disabilities of the Arm, Shoulder and Hand (DASH) scores, grip strength and pinch strength before and after arthroscopy were performed for ten included non-randomized cohort studies comprising 294 patients. Based on Hedges' g measure, we found a large effect on VAS and DASH scores, a small effect on grip strength and no effect on pinch strength. On average, VAS improved by 4.1 cm, DASH by 22 points and grip strength by 2.8 kg. Complications were reported in 4% of patients. The use of arthroscopic-assisted techniques for thumb CMC OA is still limited; however, it may be a reasonable option for patients with thumb CMC OA who do not respond to non-operative treatment.
拇指腕掌关节（CMC）骨关节炎（OA）的关节镜治疗效果尚不明确。我们进行了一项系统综述，检索了截至2016年5月的三个电子数据库，以查找描述拇指CMC OA关节镜辅助技术的研究。对纳入的10项非随机队列研究（共294例患者）进行了关节镜检查前后疼痛视觉模拟评分（VAS）、上肢、肩部和手部功能障碍评分（DASH）、握力和捏力的Meta分析。基于Hedges' g测量法，我们发现对VAS和DASH评分有较大影响，对握力有较小影响，对捏力无影响。平均而言，VAS改善了4.1 cm，DASH改善了22分，握力提高了2.8 kg。4%的患者报告有并发症。拇指CMC OA关节镜辅助技术的应用仍然有限；然而，对于非手术治疗无效的拇指CMC OA患者，它可能是一个合理的选择。
