Tsehaie Jonathan, Spekreijse Kim R, Wouters Robbert M, Slijper Harm P, Feitz Reinier, Hovius Steven E R, Selles Ruud W
Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Xpert Clinic Hilversum, Hilversum, the Netherlands.
Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Xpert Clinic Hilversum, Hilversum, the Netherlands.
J Hand Surg Am. 2018 Nov;43(11):1000-1009.e1. doi: 10.1016/j.jhsa.2018.04.014.
Initial treatment for symptomatic carpometacarpal (CMC) osteoarthritis (OA) of the thumb is usually nonsurgical. However, evidence on the effect of a hand orthosis and hand therapy for mid- and long-term results is limited, and it is unknown how many patients undergo additional surgical treatment. Therefore, the aim of this study is to describe the outcome of a hand orthosis and hand therapy for CMC OA in a large cohort study, and to evaluate the conversion rate to surgical treatment.
In this multicenter, prospective cohort study, patients treated with a hand orthosis and hand therapy for primary CMC OA between 2011 and 2014 were included. Pain (visual analog scale) and function (Michigan Hand Questionnaire) were measured at baseline, 6 weeks, 3 months, and at 12 months after the start of treatment. All patients converted to surgery were recorded between 2012 and 2016. Outcome was compared with baseline, and post hoc comparisons were made between patients who were not converted to surgery and patients who were converted to surgery after initially receiving a hand orthosis and hand therapy. Lastly, subgroup analysis was performed based on baseline pain levels.
After a mean follow-up of 2.2 ± 0.9 years, 15% of all patients were surgically treated. In the group that was not converted to surgery, pain (visual analog scale) significantly improved from 49 ± 20 at baseline to 36 ± 24 at 12 months. The Michigan Hand Questionnaire score was essentially unchanged from 65 ± 15 at baseline to 69 ± 10 at 12 months. Post hoc testing showed that improvement in pain was only significant between baseline and 6 weeks, and thereafter stabilized until 1 year after the start of treatment. The group that converted to surgery did not show any improvement in pain and function at follow-up.
In this cohort of patients with thumb CMC OA who underwent hand therapy including an orthosis, 15% of the patients underwent additional surgical treatment. The patients (85%) who did not undergo surgery improved in pain and function, although only improvements in pain were significant and clinically relevant. Most improvement was seen in the first 6 weeks and stabilized till 1 year after the start of treatment.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
拇指掌指关节（CMC）骨关节炎（OA）有症状时的初始治疗通常是非手术治疗。然而，关于手部矫形器和手部治疗对中期和长期疗效影响的证据有限，且不清楚有多少患者会接受额外的手术治疗。因此，本研究的目的是在一项大型队列研究中描述手部矫形器和手部治疗对CMC OA的疗效，并评估手术治疗的转化率。
在这项多中心前瞻性队列研究中，纳入了2011年至2014年间接受手部矫形器和手部治疗的原发性CMC OA患者。在治疗开始时的基线、6周、3个月和12个月时测量疼痛（视觉模拟量表）和功能（密歇根手功能问卷）。记录2012年至2016年间所有转为手术治疗的患者。将结果与基线进行比较，并在最初接受手部矫形器和手部治疗后未转为手术的患者与转为手术的患者之间进行事后比较。最后，根据基线疼痛水平进行亚组分析。
平均随访2.2±0.9年后，所有患者中有15%接受了手术治疗。在未转为手术的组中，疼痛（视觉模拟量表）从基线时的49±20显著改善至12个月时的36±24。密歇根手功能问卷评分从基线时的65±15基本未变至12个月时的69±10。事后检验显示，疼痛改善仅在基线和6周之间显著，此后一直稳定至治疗开始后1年。转为手术的组在随访时疼痛和功能均未显示任何改善。
在这组接受包括矫形器在内的手部治疗的拇指CMC OA患者中，15%的患者接受了额外的手术治疗。未接受手术的患者（85%）疼痛和功能有所改善，尽管只有疼痛改善显著且具有临床意义。大部分改善出现在最初6周内，并在治疗开始后1年保持稳定。
研究类型/证据水平：治疗性II级。
