关节融合术与韧带重建和肌腱介入治疗拇指掌关节关节炎：系统回顾和荟萃分析。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume Pub Date : 2025-03-01 DOI:10.1016/j.jhsa.2024.10.018

Chul-Ho Kim MD, PhD , Dong-Hoon Lee MD , Jae-Sung Lee MD, PhD , Hyoung-Seok Jung MD, PhD

{"title":"关节融合术与韧带重建和肌腱介入治疗拇指掌关节关节炎：系统回顾和荟萃分析。","authors":"Chul-Ho Kim MD, PhD , Dong-Hoon Lee MD , Jae-Sung Lee MD, PhD , Hyoung-Seok Jung MD, PhD","doi":"10.1016/j.jhsa.2024.10.018","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>Arthrodesis and ligament reconstruction and tendon interposition (LRTI) are commonly performed procedures for treatment of thumb carpometacarpal (CMC) osteoarthritis. Although LRTI is the most common surgical treatment, CMC arthrodesis has been performed because of its reported advantages. This systematic review and meta-analysis compared the differences between CMC arthrodesis and LRTI to better inform surgeons and patients when they are making treatment decisions.</div></div><div><h3>Methods</h3><div>We searched MEDLINE, Embase, and the Cochrane Library for studies published up to 27 August 2023 that directly compared arthrodesis with LRTI for thumb CMC joint arthritis. The pooled analysis compared the visual analog scale; Quick Disabilities of the Arm, Shoulder, and Hand scores; grip strength; key pinch strength; reoperation rates; and postoperative complication rates.</div></div><div><h3>Results</h3><div>Six studies describing 285 thumbs, including 141 and 155 thumbs that underwent arthrodesis and LRTI, respectively, were included. Visual analog scale (standard mean difference [SMD], −0.05; 95% CI, −0.40 to 0.30; <em>P</em> = .78), Quick Disabilities of the Arm, Shoulder, and Hand score (SMD, 0.53; 95% CI, −1.12 to 2.17; <em>P</em> = .53), and grip strength (SMD, −0.67; 95% CI, −1.85 to 0.51; <em>P</em> = .27) showed no difference between the two groups. The arthrodesis group showed significantly higher key pinch strength (SMD, 0.61; 95% CI, 0.32–0.90), reoperation rate (odds ratio, 8.02; 95% CI, 2.00–32.16), and postoperative complication rate (odds ratio, 2.08; 95% CI, 1.11–3.91; <em>I</em><sup>2</sup> = 0%) compared with the LRTI group.</div></div><div><h3>Conclusions</h3><div>Carpometacarpal arthrodesis is associated with a better key pinch strength than LRTI. Nevertheless, no significant differences were observed in functional scores and grip strength. Patients who undergo arthrodesis have higher reoperation rates and incidence of postoperative complications than those who undergo LRTI. Thus, although arthrodesis may be a better operation for patients who require high pinch strength, surgeons should also consider the higher complication compared with LRTI.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic II.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 282-291"},"PeriodicalIF":2.1000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Arthrodesis Versus Ligament Reconstruction and Tendon Interposition for Thumb Carpometacarpal Joint Arthritis: A Systematic Review and Meta-Analysis\",\"authors\":\"Chul-Ho Kim MD, PhD , Dong-Hoon Lee MD , Jae-Sung Lee MD, PhD , Hyoung-Seok Jung MD, PhD\",\"doi\":\"10.1016/j.jhsa.2024.10.018\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><div>Arthrodesis and ligament reconstruction and tendon interposition (LRTI) are commonly performed procedures for treatment of thumb carpometacarpal (CMC) osteoarthritis. Although LRTI is the most common surgical treatment, CMC arthrodesis has been performed because of its reported advantages. This systematic review and meta-analysis compared the differences between CMC arthrodesis and LRTI to better inform surgeons and patients when they are making treatment decisions.</div></div><div><h3>Methods</h3><div>We searched MEDLINE, Embase, and the Cochrane Library for studies published up to 27 August 2023 that directly compared arthrodesis with LRTI for thumb CMC joint arthritis. The pooled analysis compared the visual analog scale; Quick Disabilities of the Arm, Shoulder, and Hand scores; grip strength; key pinch strength; reoperation rates; and postoperative complication rates.</div></div><div><h3>Results</h3><div>Six studies describing 285 thumbs, including 141 and 155 thumbs that underwent arthrodesis and LRTI, respectively, were included. Visual analog scale (standard mean difference [SMD], −0.05; 95% CI, −0.40 to 0.30; <em>P</em> = .78), Quick Disabilities of the Arm, Shoulder, and Hand score (SMD, 0.53; 95% CI, −1.12 to 2.17; <em>P</em> = .53), and grip strength (SMD, −0.67; 95% CI, −1.85 to 0.51; <em>P</em> = .27) showed no difference between the two groups. The arthrodesis group showed significantly higher key pinch strength (SMD, 0.61; 95% CI, 0.32–0.90), reoperation rate (odds ratio, 8.02; 95% CI, 2.00–32.16), and postoperative complication rate (odds ratio, 2.08; 95% CI, 1.11–3.91; <em>I</em><sup>2</sup> = 0%) compared with the LRTI group.</div></div><div><h3>Conclusions</h3><div>Carpometacarpal arthrodesis is associated with a better key pinch strength than LRTI. Nevertheless, no significant differences were observed in functional scores and grip strength. Patients who undergo arthrodesis have higher reoperation rates and incidence of postoperative complications than those who undergo LRTI. Thus, although arthrodesis may be a better operation for patients who require high pinch strength, surgeons should also consider the higher complication compared with LRTI.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic II.</div></div>\",\"PeriodicalId\":54815,\"journal\":{\"name\":\"Journal of Hand Surgery-American Volume\",\"volume\":\"50 3\",\"pages\":\"Pages 282-291\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Hand Surgery-American Volume\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0363502324005495\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hand Surgery-American Volume","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0363502324005495","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

摘要

目的：关节融合术、韧带重建和肌腱插入术（LRTI）是治疗拇指腕掌骨关节炎（CMC）的常用方法。虽然LRTI是最常见的手术治疗，但CMC关节融合术因其报道的优势而被采用。本系统综述和荟萃分析比较了CMC关节融合术和LRTI之间的差异，以便更好地为外科医生和患者做出治疗决策提供信息。方法：我们检索MEDLINE、Embase和Cochrane图书馆，检索截至2023年8月27日发表的直接比较关节融合术与LRTI治疗拇指CMC关节关节炎的研究。集合分析比较视觉模拟量表；手臂，肩膀和手的快速残疾得分；握力;键夹紧强度；手术率;以及术后并发症的发生率。结果：六项研究共纳入285个拇指，其中分别有141个和155个拇指进行了关节融合术和LRTI。视觉模拟量表(标准均差[SMD]， -0.05；95% CI, -0.40 ~ 0.30；P = 0.78)，手臂、肩部和手部快速残疾评分(SMD, 0.53；95% CI, -1.12 ~ 2.17；P = 0.53)，握力(SMD, -0.67；95% CI, -1.85 ~ 0.51；P = 0.27)，两组间无差异。关节融合术组的关键夹紧强度(SMD, 0.61；95% CI, 0.32-0.90)，再手术率(优势比，8.02；95% CI, 2.00-32.16)和术后并发症发生率(优势比，2.08；95% ci, 1.11-3.91；I2 = 0%)与LRTI组比较。结论：与LRTI相比，手掌骨融合术与更好的关键捏力相关。然而，在功能评分和握力方面没有观察到显著差异。关节融合术患者的再手术率和术后并发症发生率高于LRTI患者。因此，虽然关节融合术对于对捏压强度要求较高的患者可能是一种更好的手术，但与LRTI相比，外科医生也应考虑到较高的并发症。研究类型/证据水平：治疗性II。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Arthrodesis Versus Ligament Reconstruction and Tendon Interposition for Thumb Carpometacarpal Joint Arthritis: A Systematic Review and Meta-Analysis

Purpose

Arthrodesis and ligament reconstruction and tendon interposition (LRTI) are commonly performed procedures for treatment of thumb carpometacarpal (CMC) osteoarthritis. Although LRTI is the most common surgical treatment, CMC arthrodesis has been performed because of its reported advantages. This systematic review and meta-analysis compared the differences between CMC arthrodesis and LRTI to better inform surgeons and patients when they are making treatment decisions.

Methods

We searched MEDLINE, Embase, and the Cochrane Library for studies published up to 27 August 2023 that directly compared arthrodesis with LRTI for thumb CMC joint arthritis. The pooled analysis compared the visual analog scale; Quick Disabilities of the Arm, Shoulder, and Hand scores; grip strength; key pinch strength; reoperation rates; and postoperative complication rates.

Results

Six studies describing 285 thumbs, including 141 and 155 thumbs that underwent arthrodesis and LRTI, respectively, were included. Visual analog scale (standard mean difference [SMD], −0.05; 95% CI, −0.40 to 0.30; P = .78), Quick Disabilities of the Arm, Shoulder, and Hand score (SMD, 0.53; 95% CI, −1.12 to 2.17; P = .53), and grip strength (SMD, −0.67; 95% CI, −1.85 to 0.51; P = .27) showed no difference between the two groups. The arthrodesis group showed significantly higher key pinch strength (SMD, 0.61; 95% CI, 0.32–0.90), reoperation rate (odds ratio, 8.02; 95% CI, 2.00–32.16), and postoperative complication rate (odds ratio, 2.08; 95% CI, 1.11–3.91; I² = 0%) compared with the LRTI group.

Conclusions

Carpometacarpal arthrodesis is associated with a better key pinch strength than LRTI. Nevertheless, no significant differences were observed in functional scores and grip strength. Patients who undergo arthrodesis have higher reoperation rates and incidence of postoperative complications than those who undergo LRTI. Thus, although arthrodesis may be a better operation for patients who require high pinch strength, surgeons should also consider the higher complication compared with LRTI.

Type of study/level of evidence

Therapeutic II.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of Hand Surgery-American Volume 医学-外科

CiteScore

3.20

自引率

10.50%

发文量

402

审稿时长

12 weeks

期刊介绍： The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.