Department of Surgery, Royal College of Surgeons, Dublin, Ireland.
J Hand Surg Asian Pac Vol. 2021 Jun;26(2):245-264. doi: 10.1142/S2424835521500260.
Osteoarthritis of the thumb base is the second most prevalent arthritis of the hand. Management is primarily conservative, consisting of analgesia, splinting, physiotherapy, and steroid injections. Surgery is considered when conservative measures fail. The primary objective was to assess the safety and efficacy of the surgical interventions and therein, evaluate whether any superiority exists among the available interventions. Efficacy was evaluated by examining four parameters: pain, function, range of movement and strength of the joint postoperatively. Safety was determined by comparing the rate and severity of postoperative complications. A systematic search of MEDLINE (2014-2019), EMBASE (2014-2019), CINAHL (2014-2019) and CENTRAL (2014-2019) databases was carried out. Abstracts were screened for relevant studies. Randomised controlled trials were only considered. Eight studies were included in the quantitative synthesis. The procedures evaluated are: Trapeziectomy (T), trapeziectomy with ligament reconstruction (T + LR), trapeziectomy with ligament reconstruction and tendon interposition (T + LRTI), trapeziectomy with allograft suspension (T + ALS) and joint arthrodesis (A). Low-moderate quality evidence suggests that T + LRTI yields better range of movement (palmar abduction) when compared with (T) alone; (SMD 0.61, 95% CI 0.22 to 1.00, random-effects, = 0.002). Comparing adverse events showed that arthrodesis carries a greater risk of adverse events when compared with T + LRTI; (RR 0.33, 95% CI 0.17 to 0.61, random-effects, = 0.0005). In addition, T + LRTI is preferred over arthrodesis by patients (OR 0.29 95% CI 0.09 to 0.95; = 0.04). This difference was no seen in the other comparison groups. It is difficult to declare with any degree of certainty which procedure offers the best functional outcome and safety profile. Results suggest T + LRTI yields good postoperative range of movement. Arthrodesis demonstrated an unacceptably high rate of moderate-severe complications and should be considered with careful consideration.
拇指基部骨关节炎是手部第二大常见关节炎。治疗主要是保守治疗，包括镇痛、夹板固定、物理治疗和类固醇注射。当保守治疗无效时，才会考虑手术。主要目的是评估手术干预的安全性和有效性，并评估现有干预措施中是否存在任何优势。通过检查术后四个参数：疼痛、功能、运动范围和关节强度来评估疗效。通过比较术后并发症的发生率和严重程度来确定安全性。对 MEDLINE（2014-2019 年）、EMBASE（2014-2019 年）、CINAHL（2014-2019 年）和 CENTRAL（2014-2019 年）数据库进行了系统搜索。筛选摘要以寻找相关研究。仅考虑随机对照试验。定量综合纳入了 8 项研究。评估的程序是：大多角骨切除术（T）、大多角骨切除术伴韧带重建（T+LR）、大多角骨切除术伴韧带重建和肌腱间置（T+LRTI）、大多角骨切除术伴同种异体悬带（T+ALS）和关节融合术（A）。低-中等质量证据表明，与单独（T）相比，T+LRTI 可获得更好的运动范围（掌侧外展）（SMD 0.61，95%CI 0.22 至 1.00，随机效应， = 0.002）。比较不良事件发现，与 T+LRTI 相比，融合术发生不良事件的风险更大；（RR 0.33，95%CI 0.17 至 0.61，随机效应， = 0.0005）。此外，患者更喜欢 T+LRTI 而不是融合术（OR 0.29 95%CI 0.09 至 0.95； = 0.04）。在其他比较组中没有观察到这种差异。很难有把握地宣称哪种手术提供最佳的功能结果和安全性。结果表明，T+LRTI 可获得良好的术后运动范围。融合术显示出不可接受的中重度并发症发生率高，应谨慎考虑。
