影响德-夸尔曼肌腱病手术治疗的因素：回顾性横断面观察研究

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2024-11-01 DOI:10.1016/j.jcot.2024.102790

Arjuna Thakker , Nicholas Johnson , Joseph Dias

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引用次数: 0

摘要

背景有关不同患者、社会人口和解剖学因素如何影响德-夸尔曼氏肌腱病（DQT）手术治疗的文献十分有限。目的我们假设，不同患者、解剖学或社会人口因素会影响德-夸尔曼氏肌腱病的非手术治疗与手术治疗。患者特异性因素包括年龄、性别、患手、主导手、类固醇注射量和平均注射次数。社会人口学因素包括种族、就业和贫困程度，这些因素通过 "多重贫困指数"（The Index of Multiple Deprivation）中的贫困五分位数来衡量。解剖学因素包括是否存在关节间隙下化、APL和EPB肌腱滑脱的数量、肌腱增厚、渗出性腱鞘炎、血管过多以及是否存在鞘神经节。采用双变量分析比较两组患者之间的因素，并将重要因素（p <0.05）纳入逻辑回归模型，用于预测影响手术治疗的因素。结果双变量分析发现，非手术组和手术组患者服用类固醇的平均次数存在显著差异（p = 0.001）。在社会人口学因素方面，贫困五分位数之间存在显著差异（p = 0.02）。从解剖学因素来看，手术队列中有更多患者患有多发性 APL 肌腱滑脱（p = 0.02）和存在腱鞘节（p = 0.02）。就患者和社会人口学因素而言，逻辑回归发现，类固醇的数量（每名患者）和处于贫困的五分位数4与手术治疗有关。结论本研究表明，多种因素与 DQT 的手术治疗需求相关，包括接受类固醇注射的次数、社会贫困程度以及解剖因素（如存在多处肌腱滑脱和腱鞘节）。我们的研究结果为越来越多探讨可能影响 DQT 患者治疗途径的因素的文献增添了新的内容。

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Factors influencing surgical treatment of De Quervain's tendinopathy: A retrospective cross-sectional observational study

Background

The literature surrounding how different patient, sociodemographic, and anatomical factors influence surgical treatment of De Quervain's tendinopathy (DQT) is limited.

Purpose

We hypothesised that different patient, anatomical, or sociodemographic factors influence the management of DQT with regard to non-operative vs. surgical management.

Methods

This retrospective cross-sectional study reviewed 155 cases of patients with DQT seen over a 10 year period. Patient-specific factors included age, gender, hand affected, dominant hand, steroid injection given and mean number of injections. Sociodemographic factors included ethnicity, employment, and deprivation, were measured using deprivation quintiles through The Index of Multiple Deprivation. Anatomical factors included the presence of subcompartmentalization, number of APL and EPB tendon slips, tendon thickening, exudative tenosynovitis, hypervascularization, and the presence of a sheath ganglion Patients were categorized into either non-operative or surgical cohort. Bivariate analysis was used to compare factors between the cohorts, and significant factors (p < 0.05) were included in the logistic regression model, used to predict factors influencing surgical management.

Results

Bivariate analysis detected a significant difference in the mean number of steroids given between the non-operative and surgical cohort (p = 0.001) patient factors. For sociodemographic factors, a significant difference was found between deprivation quintiles (p = 0.02). From the anatomical factors, the surgical cohort had more patients with multiple APL tendon slips (p = 0.02) and the presence of a tendon ganglion sheath ganglion (p = 0.02). For patient and sociodemographic factors, logistic regression identified that the number of steroids (per patient) and being in deprivation quintile 4 were associated with surgical treatment. For anatomical factors, multiple APL tendon slips and the presence of a tendon sheath ganglion were associated with the surgical treatment.

Conclusion

This study suggests that several factors are associated with the need for surgical treatment of DQT, including the number of steroid injections received, social deprivation, and anatomical factors, such as the presence of multiple tendon slips and a tendon sheath ganglion. Our findings add to the growing body of literature exploring factors that may influence treatment pathways for patients with DQT.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.