Jørgensen Rasmus Wejnold, Odgaard Anders, Anderson Kiran Annette, Jensen Claus Hjorth
Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Copenhagen, Denmark.
Department of Orthopedics, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.
J Wrist Surg. 2021 Oct 1;11(2):145-149. doi: 10.1055/s-0041-1735886. eCollection 2022 Apr.
Osteoarthritis of the thumb carpometacarpal joint (CMC-1 OA) is increasingly common with age. Conservative treatment with anti-inflammatory medication, thumb spica splinting, and steroid injection is recommended for early-stage OA, but some patients will continue to have refractory symptoms and surgery may be considered. We found it interesting to study outcomes of surgical treatment of cases with mild radiographic changes and yet symptoms severe enough to indicate surgery. The specific research question is, if there is a limit of radiographic changes, below which a poor patient-reported outcome (PRO) can be expected. In a retrospective cohort of patients with prospectively collected PROs, we intend to study the effect of the radiographic CMC-1 OA severity on the PRO improvement and satisfaction after interposition arthroplasty. Radiographs of 347 patients, who had CMC-1 surgery, were retrospectively analyzed. Each rater independently assessed all radiographs classifying each according to the Eaton classification. All patients had surgery with CMC-1 interposition arthroplasty using three well-known techniques that all include a complete trapeziectomy. Comparison between stage 1 and stage 2-4 was done using Chi-square test and -test. Patients with Eaton stage 1 had a mean improvement in Quick-DASH (Quick-Disability of the Arm, Shoulder, and Hand questionnaire) scores of 14.6 points. Patients with Eaton stage 2 to 4 had a mean improvement of 25.3 points. The difference between these two groups was 10.6 points ( = 0.009). Only 52% of patients with Eaton stage 1 OA were satisfied. However, 76% of patients with Eaton stage 2 to 4 were satisfied ( = 0.008, chi-square between stage 1 and stage 2-4). Patients with Eaton stage 1 CMC-1 OA had poorer PROs, as compared with more advanced stages of OA, 6 months following surgical treatment with interposition arthroplasty. Based on our results, we advise against surgical treatment with interposition arthroplasty of the very mildest CMC-1 OA, regardless of the preoperative PROs.
拇指腕掌关节骨关节炎（CMC-1 OA）的发病率随年龄增长而逐渐升高。对于早期OA，推荐采用抗炎药物、拇指人字形夹板固定及类固醇注射等保守治疗方法，但部分患者症状仍会持续难愈，此时可考虑手术治疗。我们发现，研究影像学改变轻微但症状严重到足以表明需进行手术的病例的手术治疗效果很有意思。具体研究问题是，影像学改变是否存在一个限度，低于该限度则患者报告结局（PRO）可能较差。
在一个前瞻性收集了PRO的患者回顾性队列中，我们打算研究影像学CMC-1 OA严重程度对置入关节成形术后PRO改善情况及满意度的影响。
对347例行CMC-1手术的患者的X线片进行了回顾性分析。每位评估者独立评估所有X线片，并根据伊顿分类法对每张片子进行分类。所有患者均采用三种知名技术行CMC-1置入关节成形术，所有技术均包括完整的大多角骨切除术。采用卡方检验和t检验对1期与2 - 4期进行比较。
伊顿1期患者的Quick-DASH（上肢、肩部和手部功能障碍快速评估问卷）评分平均改善14.6分。伊顿2至4期患者的平均改善为25.3分。两组之间的差异为10.6分（P = 0.009）。伊顿1期OA患者中只有52%感到满意。然而，伊顿2至4期患者中有76%感到满意（P = 0.008，1期与2 - 4期之间的卡方检验）。
与OA更晚期阶段相比，伊顿1期CMC-1 OA患者在接受置入关节成形术手术治疗6个月后的PRO较差。根据我们的研究结果，我们建议，无论术前PRO如何，对于最轻微的CMC-1 OA，不建议采用置入关节成形术进行手术治疗。
