From the Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands; Xpert Clinics, Hand and Wrist Center, Zeist, the Netherlands.
From the Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands; Xpert Clinics, Hand and Wrist Center, Zeist, the Netherlands.
J Hand Surg Am. 2023 May;48(5):469-478. doi: 10.1016/j.jhsa.2023.01.022. Epub 2023 Mar 15.
The primary aim of this study was to report complications during the first year after trapeziectomy with Weilby sling using a standardized tool designed by the International Consortium for Health Outcome Measures. The secondary aim was to determine the association of complications and patient-reported outcomes 12 months after surgery.
We included patients who underwent trapeziectomy with Weilby sling between November 2013 and December 2018. All complications during the first year were scored using the International Consortium for Health Outcomes Measurement Complications in Hand and Wrist conditions (ICHAW) tool. Pain and hand function were measured before surgery and 12 months after surgery using the Michigan Hand Outcomes Questionnaire (MHQ). Minimally Important Change thresholds of 18.6 for MHQ pain and 9.4 for MHQ function were used to determine clinical importance.
Of 531 patients after trapeziectomy with Weilby sling, 65% had an uneventful recovery, 16% experienced ICHAW Grade 1 deviations only, and 19% experienced Grade 2 or 3 deviations, including requiring antibiotics, corticosteroid injections, or additional surgery. On average, patients improved in pain and hand function, even in the presence of ICHAW events. Although all ICHAW grades were associated with poorer patient-reported outcomes 12 months after surgery, Grade 2 and 3 exceeded the Minimally Important Change threshold for pain and/or function.
In 531 patients, 65% had an uneventful recovery, 16% experienced ICHAW Grade 1 deviations only, and 19% experienced grade 2 or 3 deviations. We recommend describing Grade 1 as "adverse protocol deviations" and grade 2 and 3 as complications, because of clinically relevant poorer patient-reported outcomes 12 months after surgery. The ICHAW is a promising tool to evaluate systematically and compare complications in hand surgery, although we recommend further evaluation.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究的主要目的是使用国际健康结局测量联合会（ICHOM）设计的标准化工具报告腕掌部 Weilby 吊带切开术（trapeziectomy with Weilby sling）后 1 年内的并发症。次要目的是确定术后 12 个月并发症与患者报告结局的相关性。
我们纳入了 2013 年 11 月至 2018 年 12 月期间接受 Weilby 吊带腕掌部切开术的患者。所有并发症均采用国际健康结局测量联合会手部和腕部疾病并发症（ICHAW）工具进行评分。在手术前和手术后 12 个月，使用密歇根手功能问卷（Michigan Hand Outcomes Questionnaire，MHQ）测量疼痛和手部功能。使用 MHQ 疼痛的 18.6 分和 MHQ 功能的 9.4 分作为最小临床重要变化阈值（minimally important change threshold）来确定临床意义。
在 Weilby 吊带腕掌部切开术的 531 例患者中，65%的患者恢复顺利，16%仅出现 ICHAW 1 级偏差，19%出现 2 级或 3 级偏差，包括需要抗生素、皮质类固醇注射或进一步手术。平均而言，即使存在 ICHAW 事件，患者的疼痛和手部功能也有所改善。虽然所有 ICHAW 分级与术后 12 个月患者报告的结局较差相关，但 2 级和 3 级的疼痛和/或功能超过了最小临床重要变化阈值。
在 531 例患者中，65%的患者恢复顺利，16%仅出现 ICHAW 1 级偏差，19%出现 2 级或 3 级偏差。由于术后 12 个月患者报告的结局有临床意义的变差，我们建议将 1 级描述为“不良方案偏差”，2 级和 3 级描述为并发症。ICHOW 是一种有前途的系统评估手部手术并发症的工具，尽管我们建议进一步评估。
治疗性研究/证据等级 IV。
