The University of British Columbia, Vancouver, Canada.
University of Toronto, ON, Canada.
Hand (N Y). 2020 Nov;15(6):761-770. doi: 10.1177/1558944719834654. Epub 2019 Mar 22.
Camptodactyly is a pediatric hand condition, the treatment of which remains controversial. The authors' aim was to improve patient care through clarifying the definition of camptodactyly and indications for surgical and/or conservative management, summarizing outcomes, and defining risks. A systematic review was conducted of articles in all languages on outcomes following surgical and/or conservative management of idiopathic camptodactyly in children using MEDLINE (Medical Literature Analysis and Retrieval System Online), PubMed, EMBASE (Excerpta Medica database), AMED (Allied and Complementary Medicine), and CINAHL (Cumulative Index of Nursing and Allied Health Literature) (until January 2017). The primary outcome was posttreatment flexion contracture, and the secondary outcomes were indications for surgery, complications, and patient satisfaction. Database searching generated 16 final articles, with 7 case series and 9 retrospective cohort studies. There was a lack of consistency on the definition of camptodactyly and in outcome reporting. All 16 studies received a "Weak" global rating and demonstrated low-quality evidence, suggesting that treatment of camptodactyly with operative or nonoperative measures reduces the degree of flexion contracture in most patients (from pretreatment averages of 20°-85° to posttreatment averages of 5°-37°). There was general agreement that surgery should be reserved for contracture >30° or failure to respond to conservative management. Surgery generally led to more complications compared with conservative management. Only one study reported on functional limitations, and another reported on patient-reported outcomes. Current evidence of the effectiveness of camptodactyly treatment in addressing both joint-specific deformity and patient-perceived function and appearance is insufficient to guide patient care. Future research may consider the development of decision aids to guide patients and families through selecting management strategies and to promote shared decision making.
手握拳畸形是一种儿科手部疾病，其治疗方法仍存在争议。作者旨在通过阐明手握拳畸形的定义以及手术和/或保守治疗的适应证、总结治疗结果和定义风险来改善患者的治疗效果。作者用 MEDLINE（医学文献分析和检索系统在线）、PubMed、EMBASE（荷兰医学文摘库）、AMED（补充与替代医学数据库）和 CINAHL（护理与联合健康文献累积索引）对所有语言发表的关于儿童特发性手握拳畸形手术和/或保守治疗后结果的文章进行了系统评价，检索时间截至 2017 年 1 月。主要结果是治疗后的屈曲挛缩，次要结果是手术适应证、并发症和患者满意度。数据库搜索生成了 16 篇最终文章，其中 7 篇为病例系列研究，9 篇为回顾性队列研究。在手握拳畸形的定义和结果报告方面缺乏一致性。所有 16 项研究的总体评级为“弱”，证据质量较低，表明手术或非手术治疗手握拳畸形可降低大多数患者的屈曲挛缩程度（从治疗前的平均 20°-85°降至治疗后的平均 5°-37°）。一般认为，只有当挛缩＞30°或保守治疗无效时才应进行手术。与保守治疗相比，手术通常会导致更多的并发症。只有一项研究报告了功能限制，另一项研究报告了患者报告的结果。目前，手握拳畸形治疗在解决关节特定畸形和患者感知功能和外观方面的有效性证据不足，无法为患者护理提供指导。未来的研究可以考虑开发决策辅助工具，以帮助患者和家属选择治疗策略，并促进共同决策。
