Nuffield Orthopaedic Centre, Oxford, UK.
Bone Joint J. 2020 May;102-B(5):600-605. doi: 10.1302/0301-620X.102B5.BJJ-2019-1464.R2.
Base of thumb osteoarthritis (BTOA) is a common age-related disease which has a significant negative impact upon quality of life. Our aim was to assess current UK practice in secondary care with regard to the nature of non-surgical treatments, the surgical procedures most commonly performed, and factors influencing the surgical decision-making process.
Ten consecutive patients undergoing surgery for BTOA between March 2017 and May 2019 were prospectively identified in 15 UK centres. Demographic details, duration of symptoms, radiological grade, non-surgical management strategies, and surgery conducted were recorded. A supplementary consultant questionnaire consisting of four multiple-choice-questions (MCQ) based on hypothetical clinical scenarios was distributed.
A total of 150 patients were identified with a mean age of 64 years (SD 9), comprising 119 females and 31 males. Median duration of symptoms prior to surgery was 24 months (Interquartile range (IQR) 12 to 40). Hand therapy was used in 67 patients (45%), splints in 80 (53%), and 121 patients (81%) received one or more intra-articular injections, of which 81 (67%) were image-guided (14 (12%) ultrasound and 67 (55%) fluoroscopic). Only 48 patients (32%) received all three non-surgical treatments. Simple trapeziectomy (79 patients) and trapeziectomy with ligament reconstruction and/or tendon interposition (69 patients) were the most commonly performed operations. One patient was treated with arthrodesis, and one with arthroplasty. The supplementary questionnaire revealed that no specific patient or disease characteristics significantly influenced the type of surgery undertaken.
We found considerable variation in practice of both non-surgical and surgical management of BTOA. The proportion of patients exhausting non-surgical strategies before being offered surgery is low. Surgeons tend to favour a single type of surgery irrespective of patient or disease characteristics. Cite this article: 2020;102-B(5):600-605.
拇指基底部骨关节炎（BTOA）是一种常见的与年龄相关的疾病，对生活质量有重大负面影响。我们的目的是评估英国二级保健中关于非手术治疗的性质、最常进行的手术以及影响手术决策过程的因素的当前实践。
2017 年 3 月至 2019 年 5 月期间，在 15 个英国中心前瞻性地确定了 10 例连续接受 BTOA 手术的患者。记录人口统计学细节、症状持续时间、放射学分级、非手术治疗策略和手术情况。还分发了一份由四个基于假设临床情况的多项选择题（MCQ）组成的补充顾问问卷。
共确定了 150 例平均年龄为 64 岁（标准差 9）的患者，包括 119 名女性和 31 名男性。手术前症状持续时间的中位数为 24 个月（四分位距（IQR）12 至 40）。67 例（45%）患者接受手部治疗，80 例（53%）患者接受夹板治疗，121 例（81%）患者接受一种或多种关节内注射，其中 81 例（67%）为影像学引导（14 例（12%）超声和 67 例（55%）荧光透视）。只有 48 例（32%）患者接受了所有三种非手术治疗。单纯的大多角骨切除术（79 例）和大多角骨切除术联合韧带重建和/或肌腱间置（69 例）是最常进行的手术。1 例患者接受融合术治疗，1 例患者接受关节成形术治疗。补充问卷显示，没有特定的患者或疾病特征显著影响所进行的手术类型。
我们发现 BTOA 的非手术和手术治疗实践存在相当大的差异。在被提供手术之前，用尽非手术治疗策略的患者比例较低。外科医生倾向于选择单一类型的手术，而不考虑患者或疾病特征。
