From the Department of Hand, Plastic and Aesthetic Surgery, the Institute for Medical Information Processing, Biometry and Epidemiology, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, and the Department of Radiology, Ludwig- Maximilians-Universität München.
Plast Reconstr Surg. 2020 Jan;145(1):151-159. doi: 10.1097/PRS.0000000000006378.
This study aims to present a new therapeutic option for the treatment of thumb carpometacarpal joint osteoarthritis. Knowing that autologous fat may be beneficial for osteoarthritis through antiinflammatory and chondroprotective effects, the authors transplanted autologous adipose fat into the thumb carpometacarpal joint with the objective of postponing definite resection arthroplasty surgery.
In this pilot study, the authors performed surgery on 99 joints. The study population consisted of patients with symptomatic and radiologically confirmed osteoarthritis of the thumb carpometacarpal joint. After harvesting abdominal adipose tissue, 1 to 2 ml of fat without physical or enzymatic manipulation were transplanted into the thumb carpometacarpal joint. Surgical outcome was quantified by use of the Michigan Hand Outcomes Questionnaire in addition to strength and pain measurements during a 12-month follow-up consultation. We conducted Friedman's analysis of variance to gauge the differences over time regarding Michigan Hand Outcomes Questionnaire and pain under stress.
From 2 weeks on, there was pain relief, both under stress and at rest. Friedman's analysis of variance revealed a significant change in pain under stress [chi-square (5) = 68.52; p < 0.001]. Postoperative Michigan Hand Outcomes Questionnaire Scores improved significantly over 12 months [chi-square (5) = 90.56; p < 0.001].
The authors' preliminary findings suggest that intraarticular autologous fat transplantation is a promising alternative treatment of carpometacarpal joint osteoarthritis of the thumb.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
本研究旨在为治疗拇指腕掌关节骨关节炎提供一种新的治疗选择。由于自体脂肪可能通过抗炎和软骨保护作用有益于骨关节炎，作者将自体脂肪移植到拇指腕掌关节，以期推迟明确的关节切除成形术。
在这项初步研究中，作者对 99 个关节进行了手术。研究人群包括有症状和放射学确诊的拇指腕掌关节骨关节炎患者。在采集腹部脂肪组织后，将 1 至 2 毫升未经物理或酶处理的脂肪移植到拇指腕掌关节。手术结果通过密歇根手功能问卷进行量化，并在 12 个月的随访咨询中进行力量和疼痛测量。我们采用 Friedman 方差分析来评估密歇根手功能问卷和应激下疼痛在时间上的差异。
从第 2 周开始，无论是在应激下还是在休息时，疼痛都得到了缓解。Friedman 方差分析显示，应激下疼痛有显著变化[卡方（5）=68.52；p<0.001]。术后密歇根手功能问卷评分在 12 个月内显著提高[卡方（5）=90.56；p<0.001]。
作者的初步发现表明，关节内自体脂肪移植是拇指腕掌关节骨关节炎的一种有前途的治疗选择。
临床问题/证据水平：治疗，IV。
