Fang Evan, Behroozian Tara, Thoma Achilles
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
J Hand Microsurg. 2024 Sep 21;17(1):100160. doi: 10.1016/j.jham.2024.100160. eCollection 2025 Jan.
The outcomes of simple trapeziectomy (T) versus trapeziectomy with ligament reconstruction and tendon interposition (LRTI) for trapeziometacarpal (TMC) osteoarthritis have been compared in several systematic reviews (SRs) with conflicting results across the various outcomes studied. Despite a lack of conclusions regarding the superiority of one treatment versus the other, LRTI remains the most popular surgical option. This raises the questions of whether published SRs are of high methodological quality, and whether discordant conclusions can be attributed to differences in methodologic quality. To answer these, a SR of SRs comparing T vs LRTI was conducted.
A search of MEDLINE, EMBASE, and the Cochrane Database of SRs was performed from 1946 to September 18, 2023. SRs directly comparing T vs LRTI for TMC osteoarthritis were selected for inclusion. Methodological characteristics, results and conclusions of the selected SRs were extracted. Outcomes and conclusions were assessed for disagreement in the context of methodological differences. Quality of the included reviews was assessed using the AMSTAR 2 tool.
Seven SRs, published between 2004 and 2022, were included. Based on AMSTAR 2 criteria, all seven SRs received a quality rating of "critically low" due to weaknesses in more than one critical domain. The most frequent weaknesses in critical domains included: failure to indicate that the review followed an protocol (5 of 7 SRs), failure to provide a list of excluded studies and justification for each (5 of 7 SRs), failure to account for risk of bias from primary studies when discussing results (4 of 7 SRs), and failure to justify methods used for meta-analysis (4 of 5 meta-analyses).
SRs comparing T vs LRTI have had methodological or reporting flaws which limit confidence in results. Future SRs should ensure a rigorous methodology is followed and clearly reported in the publication.
在多项系统评价（SR）中，已对单纯大多角骨切除术（T）与大多角骨切除术联合韧带重建及肌腱植入术（LRTI）治疗第一掌腕关节（TMC）骨关节炎的疗效进行了比较，在所研究的各种结局中结果相互矛盾。尽管对于一种治疗方法优于另一种治疗方法尚无定论，但LRTI仍然是最受欢迎的手术选择。这就引发了以下问题：已发表的SR在方法学质量上是否较高，以及不一致的结论是否可归因于方法学质量的差异。为了回答这些问题，进行了一项比较T与LRTI的SR的SR。
检索了1946年至2023年9月18日的MEDLINE、EMBASE和Cochrane系统评价数据库。选择直接比较T与LRTI治疗TMC骨关节炎的SR纳入研究。提取所选SR的方法学特征、结果和结论。在方法学差异的背景下评估结局和结论的不一致性。使用AMSTAR 2工具评估纳入综述的质量。
纳入了2004年至2022年发表的7篇SR。根据AMSTAR 2标准，由于多个关键领域存在缺陷，所有7篇SR的质量评级均为“极低”。关键领域中最常见的缺陷包括：未表明该综述遵循方案（7篇SR中的5篇）、未提供排除研究的列表及其各自的理由（7篇SR中的5篇）、在讨论结果时未考虑原始研究的偏倚风险（7篇SR中的4篇）以及未对荟萃分析所使用的方法进行论证（5项荟萃分析中的4项）。
比较T与LRTI的SR存在方法学或报告方面的缺陷，这限制了对结果的可信度。未来的SR应确保遵循严格的方法学并在出版物中清晰报告。
