Rezzadeh Kevin, Donnelly Megan, Daar David, Hacquebord Jacques
Department of Orthopaedic Surgery, School of Medicine, New York University, New York.
Hansjörg Wyss Department of Plastic Surgery, School of Medicine, New York University, New York.
J Wrist Surg. 2020 Jun;9(3):263-267. doi: 10.1055/s-0039-1692477. Epub 2019 Jul 12.
A common notion is that more complex techniques for treating trapeziometacarpal arthritis such as ligament reconstruction and tendon interposition (LRTI) better preserve the scaphometacarpal (SMC) space compared to a simple trapeziectomy and that this leads to superior functional outcomes. The purpose of this systematic review is to evaluate the relationship between scaphometacarpal space and objective outcomes such as grip and pinch strength as well as subjective patient-reported outcomes. A systematic review of the literature was conducted according to PRISMA guidelines. Inclusion criteria were studies reporting SMC space and outcomes after surgery for carpometacarpal arthritis. The primary outcomes of these studies included any measure of postoperative scaphometacarpal space (trapezial height/trapezial index) as well as key pinch strength, grip strength, or lateral pinch strength. Studies that did not assess for association between SMC space and outcomes were excluded. Fourteen studies were included in this systematic review. Three (21.4%) studies found a statistically significant correlation between postoperative SMC space and postoperative pinch or grip strength. The correlation was weakly positive in one study (key pinch vs. scaphometacarpal space, = 0.13), positive but unlisted in another (lateral pinch vs. trapezial ratio), and negative in the third study (key pinch vs. trapezial space ratio, = -0.47). Preservation of the SMC space postoperatively is not associated with postoperative outcomes. Further research is necessary to better characterize the importance of maintaining the SMC space in patients undergoing LRTI in order to substantiate claims by proponents of the procedure.
一种普遍的观点认为，与单纯的大多角骨切除术相比，诸如韧带重建和肌腱嵌入（LRTI）等治疗大多角骨掌关节炎的更复杂技术能更好地保留舟大多角骨关节（SMC）间隙，并且这会带来更好的功能结果。本系统评价的目的是评估舟大多角骨关节间隙与诸如握力和捏力等客观结果以及患者主观报告结果之间的关系。根据PRISMA指南对文献进行了系统评价。纳入标准是报告腕掌关节炎手术后SMC间隙和结果的研究。这些研究的主要结果包括术后舟大多角骨关节间隙的任何测量值（大多角骨高度/大多角骨指数）以及关键捏力、握力或侧捏力。未评估SMC间隙与结果之间关联的研究被排除。本系统评价纳入了14项研究。三项（21.4%）研究发现术后SMC间隙与术后捏力或握力之间存在统计学显著相关性。在一项研究中相关性为弱阳性（关键捏力与舟大多角骨关节间隙，r = 0.13），在另一项研究中为阳性但未列出（侧捏力与大多角骨比率），在第三项研究中为阴性（关键捏力与大多角骨间隙比率，r = -0.47）。术后保留SMC间隙与术后结果无关。有必要进行进一步研究，以更好地描述在接受LRTI的患者中维持SMC间隙的重要性，以便证实该手术支持者的说法。
