Harvard Medical School, Boston, MA, USA.
Hand (N Y). 2023 Nov;18(8):1275-1283. doi: 10.1177/15589447221093669. Epub 2022 May 13.
The goals of this study are to describe the reoperation rates in patients who underwent Wilson osteotomy compared with patients who underwent carpometacarpal (CMC) arthroplasty for early-stage arthritis and to evaluate the factors influencing the patient-reported outcomes.
Retrospectively, 52 patients who underwent surgery for stage I/II osteoarthritis of the thumb carpometacarpal were identified, consisting of 17 (33%) patients who underwent Wilson osteotomy and 35 (67%) who underwent carpometacarpal arthroplasty. A total of 28 (55%) patients completed the outcome questionnaires, consisting of 11 (39%) patients who underwent Wilson osteotomy and 17 (61%) patients who underwent carpometacarpal arthroplasty. We performed a multivariable linear regression model to identify factors associated with the Numeric Rating Scale (NRS) pain intensity at final follow-up.
Among the patients who underwent CMC arthroplasty, 2 had a reoperation. Among the patients who underwent Wilson osteotomy, 3 had a reoperation. Among the patients who completed the outcome questionnaires, the median quick Disabilities of the Arm, Shoulder and Hand score was 10 and the median NRS Pain Intensity score was 0. In multivariable analysis, the postoperative Patient-Reported Outcomes Measurement Information System Pain Interference (PROMIS PI) was independently associated with higher postoperative NRS pain scores.
In younger patients with stage I/II CMC osteoarthritis, Wilson osteotomy may be a reasonable alternative to CMC arthroplasty. Outcomes were similar between both groups at mid-term follow-up, with only a slightly higher pain score in the osteotomy group. In patients with stage I/II carpometacarpal osteoarthritis, the PROMIS PI is the main factor indicating successful outcomes.
本研究的目的是描述行 Wilson 截骨术与行腕掌关节（CMC）关节成形术治疗早期关节炎的患者的再手术率，并评估影响患者报告结局的因素。
回顾性分析了 52 例 I/II 期拇指腕掌关节炎患者的手术资料，其中 17 例（33%）行 Wilson 截骨术，35 例（67%）行 CMC 关节成形术。共有 28 例（55%）患者完成了结局问卷，其中 11 例（39%）行 Wilson 截骨术，17 例（61%）行 CMC 关节成形术。我们进行了多变量线性回归模型分析，以确定与最终随访时数字评定量表（NRS）疼痛强度相关的因素。
行 CMC 关节成形术的患者中有 2 例再手术，行 Wilson 截骨术的患者中有 3 例再手术。完成结局问卷的患者中，快速上肢、肩部和手部残疾问卷（DASH）的中位数为 10，NRS 疼痛强度的中位数为 0。多变量分析显示，术后患者报告结局测量信息系统疼痛干扰（PROMIS PI）与术后 NRS 疼痛评分较高独立相关。
在 I/II 期 CMC 腕掌关节炎的年轻患者中，Wilson 截骨术可能是 CMC 关节成形术的合理替代方案。两组在中期随访时的结果相似，截骨组的疼痛评分略高。在 I/II 期腕掌关节炎患者中，PROMIS PI 是预示良好结局的主要因素。
