掌骨间关节假体失败与梯形骨大小的相关性。生存分析。
Assocation between trapezium size and failure of total trapeziometacarpal prosthesis. A survival analysis.
机构信息
Discipline of Orthopaedics, University of Valladolid, Valladolid, Spain.
Hospital Clínico Universitario, Avenida Ramón y Cajal, s/n, Valladolid, 47005, Spain.
出版信息
Arch Orthop Trauma Surg. 2024 Sep;144(9):4275-4282. doi: 10.1007/s00402-024-05525-w. Epub 2024 Sep 13.
AIMS
To assess the survival function of cementless total trapezium metacarpal prostheses (TTMPs) at 20 years, to compare survival functions by trapezium size, and to evaluate the association between the instantaneous risk of TTMP failure and small trapezium size using a multivariate Cox regression model.
METHODS
This observational cohort study included 221 consecutive patients with a mean follow-up after TTMP of 137.3 months (maximum of 246 months). Kaplan-Meier and actuarial life-table methods were used to evaluate the survival function of thecohort. Kaplan-Meier survival curves were compared by trapezium size. Multivariate Cox regression analysis was used to determine the effect of potential confounders on the association between small trapezium and the instantaneous risk of TTMP failure.
RESULTS
At the end of follow-up, there was a 89.01% chance of the TTMP surviving for 246 months or more. There was an association between TTMP survival time and trapezium size showing a significant trend such that the survival curves weresignificantly higher with larger trapezium size (Mantel-Cox test, p = 0.0001; WilcoxonBreslow test, p = 0.0002; Tarone-Ware test, p = 0.0001).The unadjusted Cox regression model showed a significant association between small trapezium size (smaller than 9 mm) and the instantaneous risk of TTPM failure (HR: 7.37, 95% CI: 2.46-22.07). In the multivariate Cox analysis, "age", "trapezium morphology", and "complications" were confounders in the association between small trapezium size and the hazard ratio of prosthetic failure (HR = 3.76; 95% CI 0.96 to 13.82).
CONCLUSION
These results confirm the long-term functional survival of TTMP prostheses and reveal a significant increase in trend of the survival curve with larger trapezium size. Patient age, trapezium morphology, and the presence of post-surgical complications are confounders in the association between small trapezium size and the hazard ratio of TTMP failure.
目的
评估非骨水泥全掌骨假体（TTMP）20 年的生存功能，比较不同大小掌骨的生存功能，并使用多变量 Cox 回归模型评估 TTMP 失败的瞬时风险与小掌骨大小之间的关系。
方法
本观察性队列研究纳入了 221 例连续患者，TTMP 后的平均随访时间为 137.3 个月（最长随访时间为 246 个月）。使用 Kaplan-Meier 和生存表法评估队列的生存功能。Kaplan-Meier 生存曲线按掌骨大小进行比较。使用多变量 Cox 回归分析确定潜在混杂因素对小掌骨与 TTMP 失败瞬时风险之间关系的影响。
结果
随访结束时，TTMP 有 89.01%的机会在 246 个月或更长时间内存活。TTMP 生存时间与掌骨大小之间存在关联，显示出显著的趋势，即掌骨越大，生存曲线越高（Mantel-Cox 检验，p = 0.0001；Wilcoxon-Breslow 检验，p = 0.0002；Tarone-Ware 检验，p = 0.0001）。未调整的 Cox 回归模型显示，小掌骨大小（小于 9 毫米）与 TTMP 失败的瞬时风险之间存在显著关联（HR：7.37，95%CI：2.46-22.07）。在多变量 Cox 分析中，“年龄”、“掌骨形态”和“并发症”是小掌骨大小与假体失败风险比之间关联的混杂因素（HR = 3.76；95%CI 0.96 至 13.82）。
结论
这些结果证实了 TTMP 假体的长期功能生存，并揭示了掌骨大小与生存曲线趋势之间的显著增加。患者年龄、掌骨形态和术后并发症的存在是小掌骨大小与 TTMP 失败风险比之间关联的混杂因素。
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