Saab Marc, Chick Gregoire
Department of Orthopaedics, Roger Salengro Hospital, Lille, France.
Hand & Wrist Unit, La Tour Hospital, Geneva, Switzerland.
Bone Jt Open. 2021 Mar;2(3):141-149. doi: 10.1302/2633-1462.23.BJO-2020-0188.R1.
The objective of this systematic review was to describe trapeziectomy outcomes and complications in the context of osteoarthritis of the base of the thumb after a five-year minimum follow-up.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to guide study design, and 267 full-text articles were assessed for eligibility. After exclusion criteria application, 22 studies were included, involving 728 patients and 823 trapeziectomies. Outcomes included pre- and postoperative clinical and radiological characteristics. Complications and revisions were recorded.
All the studies reported good results regarding pain and range of motion at the last follow-up of 8.3 years (5 to 22); the mean satisfaction rate was 91% (84% to 100%). It was difficult to assess the impact on metacarpophalangeal joint motion in extension with contrary results. The key pinch returned to its preoperative values, whereas tip pinch showed a modest improvement (+14%), with a mild improvement found in grip strength (+25%) at the last follow-up. The mean progressive trapezial collapse was 48% (0% to 85%) and was not correlated with pain, grip strength, or satisfaction. The most represented complications were linked to tendons or nerves affected during additional procedures to stabilize the joint (11.6%; n = 56). Mechanical complications included symptomatic scapho-M1 impingement (3.1%; n = 15/580), leading to nine surgical revisions out of 581 trapeziectomies. Meta-analysis was not possible due to study heterogeneity and limited data.
After a minimum five-year follow-up, trapeziectomy achieved high patient satisfaction and pain relief. However, strength seemed to be deteriorating with detrimental consequences, but this did not correlate with trapezial collapse. The issues related to underestimating mechanical complications and varying degrees of success should be highlighted in the information given to patients. Evidence-based analyses should help the surgeon in their decision-making. Cite this article: 2021;2(3):141-149.
本系统评价的目的是在至少随访五年的情况下，描述拇指基底骨关节炎患者行大多角骨切除术后的疗效及并发症。
采用系统评价和Meta分析的首选报告项目（PRISMA）指南指导研究设计，评估267篇全文文章的纳入资格。应用排除标准后，纳入22项研究，涉及728例患者和823例大多角骨切除术。结局指标包括术前和术后的临床及影像学特征。记录并发症和翻修情况。
所有研究均报告在末次随访8.3年（5至22年）时，疼痛和活动范围方面效果良好；平均满意率为91%（84%至100%）。评估大多角骨切除术对掌指关节伸展活动的影响存在困难，结果相互矛盾。关键捏力恢复到术前水平，而指尖捏力有适度改善（+14%），末次随访时握力有轻度改善（+25%）。大多角骨平均进行性塌陷为48%（0%至85%），且与疼痛、握力或满意度无关。最常见的并发症与在稳定关节的附加手术过程中受影响的肌腱或神经有关（11.6%；n = 56）。机械性并发症包括有症状的舟状骨-第一掌骨撞击（3.1%；n = 15/580），在581例大多角骨切除术中导致9例手术翻修。由于研究的异质性和数据有限，无法进行Meta分析。
至少随访五年后，大多角骨切除术使患者满意度较高且疼痛缓解。然而，力量似乎在下降并产生有害后果，但这与大多角骨塌陷无关。在向患者提供的信息中应强调低估机械性并发症和不同程度成功率的问题。基于证据的分析应有助于外科医生进行决策。引用本文：2021；2(3):141 - 149。
