Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford.
Department of Plastic Surgery, Wexham Park Hospital, Slough.
Rheumatology (Oxford). 2021 Sep 1;60(9):4262-4271. doi: 10.1093/rheumatology/keaa925.
Intra-articular steroid injection is commonly used to treat base of thumb osteoarthritis (BTOA), despite a lack of large-scale data on safety and effectiveness. We estimate the incidence of serious complications and further procedures following BTOA injection, including the risk of post-operative serious surgical site infection for subsequent operative intervention.
Hospital Episode Statistics data linked to mortality records from 1 April 1998 to 31 March 2017 were used to identify all BTOA injections undertaken in adults in the National Health Service secondary care in England. Patients were followed up longitudinally until death or 31 March 2017. A multivariable regression with a Fine and Gray model adjusting for the competing risk of mortality in addition to age, sex and socioeconomic deprivation was used to identify factors associated with progression to further procedure. Secondary outcomes included serious complications after injection and subsequent surgical site infection.
A total of 19 120 primary injections were performed during the 19-year period in 18 356 patients. Of these 76.5% were female; mean age 62 years (s.d. 10.6); 50.48% underwent further procedure; 22.40% underwent surgery. Median time to further intervention was 412 days (IQR 110-1945). Female sex was associated with increased risk of proceeding to surgery. Serious complication rate following injection was 0.04% (0.01-0.08) within 90 days. Of those proceeding to surgery 0.16% (0.06-0.34) presented with a wound infection within 30 days and 90 days, compared with an overall post-operative wound infection rate of 0.03% (0.02-0.05).
Very low rates of serious complications were identified following BTOA injections performed in secondary care; only one in five patients proceeded to subsequent surgery.
clinicaltrials.gov, https://www.clinicaltrials.gov, NCT03573765.
尽管缺乏关于关节内类固醇注射治疗拇指基底部骨关节炎（BTOA）安全性和有效性的大规模数据，但该方法仍被广泛用于治疗 BTOA。我们评估了 BTOA 注射后的严重并发症和进一步治疗的发生率，包括随后手术干预时术后严重手术部位感染的风险。
使用 1998 年 4 月 1 日至 2017 年 3 月 31 日的医院出院统计数据，链接到死亡率记录，以确定在英格兰国家医疗服务体系二级保健中接受 BTOA 注射的所有成年患者。患者进行了纵向随访，直到死亡或 2017 年 3 月 31 日。使用 Fine 和 Gray 模型的多变量回归，除了年龄、性别和社会经济剥夺之外，还调整了死亡率的竞争风险，以确定与进一步治疗进展相关的因素。次要结果包括注射后出现严重并发症和随后的手术部位感染。
在 19 年期间，18356 名患者共进行了 19120 次初次注射。其中 76.5%为女性；平均年龄 62 岁（标准差 10.6）；50.48%接受了进一步治疗；22.40%接受了手术。中位时间为 412 天（IQR 110-1945）。女性性别与手术风险增加相关。注射后 90 天内严重并发症发生率为 0.04%（0.01-0.08）。在接受手术的患者中，有 0.16%（0.06-0.34）在 30 天和 90 天内出现伤口感染，而术后总体伤口感染率为 0.03%（0.02-0.05）。
在二级保健中进行 BTOA 注射后，严重并发症发生率非常低；只有五分之一的患者随后进行了手术。
clinicaltrials.gov，网址：https://www.clinicaltrials.gov，NCT03573765。
