Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.
Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.
Osteoarthritis Cartilage. 2018 Nov;26(11):1506-1510. doi: 10.1016/j.joca.2018.06.014. Epub 2018 Jul 21.
Greater joint laxity and radial subluxation of the thumb metacarpal base have been shown to be risk factors for the development of trapeziometacarpal osteoarthritis in an asymptomatic and radiographically normal joint. Despite this, it is unknown whether joint laxity changes with disease progression from mild to severe osteoarthritis. This study aimed to investigate the relationship between joint laxity and osteoarthritis severity, using the trapeziometacarpal subluxation ratio as an indicator of joint laxity.
Baseline data were used from the first 100 participants included in the COMBO (Efficacy of combined conservative therapies on clinical outcomes in base of thumb OA) trial. All participants had bilateral posteroanterior (PA) and Eaton stress view hand radiographs, as well as grip and tip-pinch strength measurements. The PA view was used to assess Kellgren-Lawrence and Eaton grades, and the Eaton stress view was used to assess the trapeziometacarpal joint subluxation ratios. Generalised estimating equations were utilized to account for the fact that hand data are paired, and within-person measurements are therefore not independent.
Lower radial subluxation ratios were associated with higher Kellgren-Lawrence grades (B-coefficient -0.302; p-value 0.027), and lower grip strength scores (B-coefficient 2.06; p-value 0.006).
Radial subluxation ratios decreased with increasing disease severity, contrary to the progression from a normal joint to one with mild osteoarthritis, wherein higher joint laxity is a risk factor for disease. This may be explained by the mechanical stabilization provided by osteophytes and capsular changes in worsening osteoarthritis, as has been shown to be the case in the knee.
ACTRN 12616000353493.
III.
已有研究表明，拇指掌骨基底的关节松弛度增加和桡侧半脱位是无症状且影像学正常关节发生 trapeziometacarpal 骨关节炎的危险因素。尽管如此，目前尚不清楚关节松弛度是否会随着疾病从轻度进展到重度骨关节炎而发生变化。本研究旨在通过 trapeziometacarpal 半脱位率来评估关节松弛度与骨关节炎严重程度之间的关系。
使用 COMBO（拇指 OA 基地联合保守疗法的疗效）试验中纳入的前 100 名参与者的基线数据。所有参与者均接受双侧后前（PA）和 Eaton 应力位手 X 线片，以及握力和指尖捏力测量。PA 位 X 线片用于评估 Kellgren-Lawrence 和 Eaton 分级，Eaton 应力位 X 线片用于评估 trapeziometacarpal 关节半脱位率。利用广义估计方程来解释手部数据是配对的，因此个体内测量并不独立。
较低的桡侧半脱位率与较高的 Kellgren-Lawrence 分级（B 系数 -0.302；p 值 0.027）和较低的握力评分（B 系数 2.06；p 值 0.006）相关。
桡侧半脱位率随着疾病严重程度的增加而降低，与从正常关节进展到轻度骨关节炎相反，在轻度骨关节炎中，较高的关节松弛度是疾病的危险因素。这可能是由于骨赘和囊变在病情恶化的骨关节炎中提供的机械稳定性所致，正如在膝关节中所观察到的那样。
ACTRN 12616000353493。
III 级。
