Ai-Wei Kumar Annora, Lawson-Smith Matthew
Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, WA, Australia.
School of Medicine, The University of Notre Dame, Fremantle, WA, Australia.
J Hand Surg Glob Online. 2025 Mar 3;7(3):100708. doi: 10.1016/j.jhsg.2025.02.001. eCollection 2025 May.
Thumb carpometacarpal osteoarthritis (CMC OA) is a common condition associated with functional limitations and pain. Surgical interventions for CMC OA include simple trapeziectomy, ligament reconstruction and tendon interposition, arthrodesis, and joint replacement. The aim of this review was to evaluate the comparative effectiveness of surgical techniques.
A systematic review was performed, and the Medline, EMBASE, and SCOPUS databases were searched. Randomized controlled trials (RCTs) investigating the surgical management of CMC OA were included. The outcomes of interest were long-term pain reduction (visual analog scale), complications, and functional improvement (Disabilities of Arm, Shoulder and Hand questionnaire). Bayesian network meta-analyses were conducted, and longitudinal analysis of complication severity was performed using the Kruskal-Wallis H test.
There were 26 RCTs included, representing 19 surgical techniques and 1,193 hands. The average follow-up period was 29 months. In the analyses of pain, simple trapeziectomy ranked first, and trapeziectomy with button ranked last. Uncemented joint replacement ranked first in the analyses of function. Trapeziectomy alone demonstrated the most favorable results regarding avoidance of complications, and arthrodesis with plate and screw ranked last in the analysis of complications. Alternative surgical techniques were associated with a relative increase in complication severity across all time periods (χ(2) = 22.92, 46.82, and 7.01 after 0-3, 3-12, and 12+ months; < .001, <.001, and .03, respectively).
Our findings demonstrate that simple trapeziectomy is effective at relieving the pain associated with CMC OA and minimizing postoperative complications, demonstrating a relative increase in both the number and severity of complications after alternative surgical techniques.
Our review supports the use of simple trapeziectomy as the mainstay of surgical management of CMC OA, providing the foundation for research investigating metacarpal subsidence, trapeziometacarpal biomechanics, and implant dynamics in patients with CMC OA.
拇指腕掌关节骨关节炎（CMC OA）是一种常见疾病，伴有功能受限和疼痛。CMC OA的手术干预措施包括单纯大多角骨切除术、韧带重建和肌腱植入、关节融合术以及关节置换术。本综述的目的是评估手术技术的比较效果。
进行了一项系统综述，并检索了Medline、EMBASE和SCOPUS数据库。纳入了研究CMC OA手术治疗的随机对照试验（RCT）。感兴趣的结局指标为长期疼痛减轻（视觉模拟量表）、并发症及功能改善（手臂、肩部和手部功能障碍问卷）。进行了贝叶斯网络荟萃分析，并使用Kruskal-Wallis H检验对并发症严重程度进行纵向分析。
纳入了26项RCT，代表19种手术技术和1193只手。平均随访期为29个月。在疼痛分析中，单纯大多角骨切除术排名第一，带纽扣的大多角骨切除术排名最后。非骨水泥型关节置换术在功能分析中排名第一。单纯大多角骨切除术在避免并发症方面显示出最有利的结果，钢板螺钉关节融合术在并发症分析中排名最后。在所有时间段内，替代手术技术均与并发症严重程度的相对增加相关（0至3个月、3至12个月和12个月以上后的χ²分别为22.92、46.82和7.01；P值分别＜0.001、＜0.001和0.03）。
我们的研究结果表明，单纯大多角骨切除术在缓解与CMC OA相关的疼痛及使术后并发症最小化方面有效，显示出替代手术技术后并发症数量和严重程度均相对增加。
我们的综述支持将单纯大多角骨切除术作为CMC OA手术治疗的主要方法，为研究CMC OA患者的掌骨下沉、大多角掌骨生物力学及植入物动力学提供了基础。
