Department of Orthopaedic Surgery, Graduate School of Medicine, University of Tokyo Hospital, University of Tokyo, Tokyo, Japan.
Department of Orthopaedic Surgery, Graduate School of Medicine, University of Tokyo Hospital, University of Tokyo, Tokyo, Japan.
J Hand Surg Am. 2021 Sep;46(9):817.e1-817.e7. doi: 10.1016/j.jhsa.2021.01.009. Epub 2021 Mar 13.
This retrospective study aimed to analyze the initial clinical factors associated with surgical intervention for osteoarthritis of the thumb carpometacarpal (CMC) joint.
The study included patients who first visited our hand surgery clinic, were given the diagnosis of osteoarthritis of the thumb CMC joint between May 2012 and January 2015, and were observed for more than 3 years. Patients were classified into 2 groups according to whether they had undergone surgery during the follow-up period. The following variables were extracted and included in a bivariate analysis: sex, age, age at onset, disease duration, dominant hand, pain visual analog scale (VAS) scores at rest and during use, night pain, Eaton classification, use of an orthosis, number of injections, tender area, range of motion, grip strength, pinch strength, Kapandji abduction index, palmar abduction distance, grind test results, CMC joint shape on radiographs, dorsal subluxation ratio, volar tilt of the metacarpal, presence or absence of ossicles, and the surgeon who recommended the surgery. Variables with P values less than .05 in the bivariate analysis were included in a logistic regression model.
The study included 80 thumbs of 48 patients. Pain scores at rest and during use, and the dorsal subluxation ratio were identified as factors significantly associated with surgical intervention in the bivariate analysis. The subsequent logistic regression analysis including these factors as explanatory variables also identified the VAS score at rest and dorsal subluxation ratio as significantly associated with surgical intervention.
The VAS score at rest and the dorsal subluxation ratio at the first clinical visit were associated with the likelihood of future surgical intervention within 3 years in patients with osteoarthritis of the thumb CMC joint.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
本回顾性研究旨在分析与拇指腕掌（CMC）关节骨关节炎初次手术干预相关的临床因素。
本研究纳入了 2012 年 5 月至 2015 年 1 月期间首次到我院手外科就诊并被诊断为拇指 CMC 关节骨关节炎且随访时间超过 3 年的患者。根据随访期间是否接受手术，将患者分为 2 组。提取并纳入单变量分析的变量包括：性别、年龄、发病年龄、病程、优势手、静息和使用时疼痛视觉模拟评分（VAS）、夜间疼痛、Eaton 分类、使用矫形器、注射次数、压痛区、活动度、握力、捏力、Kapandji 外展指数、掌侧外展距离、研磨试验结果、X 线片上 CMC 关节形态、背侧半脱位比、掌骨倾斜度、有无籽骨、以及推荐手术的外科医生。单变量分析中 P 值小于.05 的变量纳入逻辑回归模型。
本研究纳入了 48 例患者的 80 个拇指。静息和使用时的疼痛评分以及背侧半脱位比在单变量分析中被确定为与手术干预显著相关的因素。包括这些因素作为解释变量的后续逻辑回归分析也确定了静息 VAS 评分和背侧半脱位比与手术干预显著相关。
在拇指 CMC 关节骨关节炎患者中，初次就诊时的静息 VAS 评分和背侧半脱位比与 3 年内未来手术干预的可能性相关。
研究类型/证据水平：预后 IV 级。
