Suwannaphisit Sitthiphong, Chuaychoosakoon Chaiwat
Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand.
Ann Med Surg (Lond). 2022 Apr 13;77:103620. doi: 10.1016/j.amsu.2022.103620. eCollection 2022 May.
This systematic review of randomized controlled trials was undertaken to assess whether any of the various currently used surgical interventions have better functional outcomes and less impairment or fewer surgical complications compared to the other common surgical interventions in de Quervain's disease.
Relevant studies related to surgical interventions in de Quervain's disease based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were identified from PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials for randomized controlled trials comparing surgical interventions in de Quervain's disease published from January 2000 to December 2020. Functional outcome and impairment were the primary outcomes assessed.
Three trials met the eligibility criteria which were following randomized controlled trial or quasi-experimental trial enrolling adults ≥18 years of age diagnosed with de Quervain's disease, comparing clinical outcomes between different surgical interventions, and including functional outcomes, impairment, pain and complications data. The Cochrane Risk of Bias Assessment Tool and GRADE approach were used to ascertain methodological quality. Statistical heterogeneity was tested with I-square and chi-square tests. The longitudinal skin incision probably slightly reduced superficial radial nerve injury, vein injury, scar hypertrophy, and total complications compared with the transverse skin incision with relative risk: 0.14, very low certainty by GRADE; 0.10, very low certainty by GRADE; 0.57, very low certainty by GRADE; and 0.23, very low certainty by GRADE, respectively.
Concerning the analysis of functional and pain scores, no significant results were able to be concluded. This study's findings must be considered in the light of quality and sample size limitations, and further high quality prospective randomized controlled clinical trials are needed to draw more firm conclusions.
本系统评价随机对照试验旨在评估与其他治疗桡骨茎突狭窄性腱鞘炎的常见手术干预措施相比，目前使用的各种手术干预措施是否具有更好的功能结局、更少的功能损害或更少的手术并发症。
根据系统评价和Meta分析的首选报告项目（PRISMA）报告指南，从PubMed、Embase、科学网和Cochrane对照试验中央注册库中检索2000年1月至2020年12月发表的比较桡骨茎突狭窄性腱鞘炎手术干预措施的随机对照试验相关研究。功能结局和功能损害为主要评估结局。
三项试验符合纳入标准，这些试验为随机对照试验或准实验性试验，纳入年龄≥18岁、诊断为桡骨茎突狭窄性腱鞘炎的成年人，比较不同手术干预措施的临床结局，并包括功能结局、功能损害、疼痛和并发症数据。采用Cochrane偏倚风险评估工具和GRADE方法确定方法学质量。用I²检验和卡方检验检验统计异质性。与横向皮肤切口相比，纵向皮肤切口可能会略微降低桡神经浅支损伤、静脉损伤、瘢痕增生和总并发症的发生率，相对风险分别为：0.14，GRADE评估为极低确定性；0.10，GRADE评估为极低确定性；0.57，GRADE评估为极低确定性；0.23，GRADE评估为极低确定性。
关于功能和疼痛评分的分析，未能得出显著结果。本研究结果必须结合质量和样本量限制来考虑，需要进一步开展高质量的前瞻性随机对照临床试验以得出更确切的结论。
