手术技术与关节注射治疗拇指基底骨关节炎的比较：系统综述

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-03-01 DOI:10.1016/j.jhsg.2024.12.005

Saiuj Bhat MD, BPhil (Hons) , Lewis Weeda MD, MPH , Ishith Seth MD, MS , Warren M. Rozen MD, PhD

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引用次数: 0

摘要

目的对拇指腕掌关节关节炎的各种手术和注射干预进行最新的系统综述。方法系统检索MEDLINE、Embase、Web of Science和Cochrane数据库自成立之日起至2024年4月的文献，以确定比较手术和/或微创干预治疗拇指CMC关节骨性关节炎的前瞻性、随机研究，随访时间至少为12个月。筛选以往评论的参考文献清单，以确定其他出版物。由于数据的明显异质性和统计能力不足，根据效果的方向（统计上较高、较低或无差异）对主要和次要结局进行定性分析。Cochrane的偏倚风险2工具评估了纳入研究的质量。结果本综述纳入了17项研究，涉及1166个拇指。14项研究比较了手术干预，而3项研究比较了各种关节内注射。5项研究具有低偏倚风险，8项具有中等偏倚风险，4项具有高偏倚风险。关于主要结局，梯形切除术与关节置换术在功能上无差异，部分梯形切除术与全梯形切除术在关键捏紧强度上无差异，梯形切除术与关节融合术在疼痛和功能上无差异。与梯形切除术相比，关节融合术的并发症发生率更高。与皮质类固醇注射相比，富血小板血浆注射改善了疼痛、功能和患者满意度。结论手术干预治疗第一CMC关节骨性关节炎无明显优势。梯形切除术仍然是最简单和最成熟的手术方式之一，具有良好的长期疗效和可接受的副作用。富血小板血浆注射可能是一种有用的替代皮质类固醇治疗首发CMC骨关节炎。研究类型/证据水平：治疗IB。

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Comparison of Surgical Techniques and Joint Injections for Base of Thumb Osteoarthritis: A Systematic Review

Purpose

To perform an updated systematic review investigating the various surgical and injection interventions for thumb carpometacarpal (CMC) joint arthritis.

Methods

A systematic literature search was conducted in MEDLINE, Embase, Web of Science, and Cochrane databases from inception to April 2024 to identify prospective, randomized studies comparing surgical and/or minimally invasive interventions for thumb CMC joint osteoarthritis with a minimum follow-up of 12 months. Reference lists of previous reviews were screened to identify additional publications. Qualitative analysis was performed for primary and secondary outcomes based on the direction of effect (statistically higher, lower, or no difference) because of marked heterogeneity of data and inadequate statistical power. Cochrane’s risk of bias 2 tool assessed the quality of included studies.

Results

Seventeen studies encompassing 1,166 thumbs were included in this review. Fourteen studies compared surgical interventions, whereas three studies compared various intra-articular injections. Five studies had a low risk of bias, eight had a moderate risk of bias, and four had a high risk of bias. Regarding primary outcomes, there was no difference in function between trapeziectomy and arthroplasty, key pinch strength between partial and total trapeziectomy, and pain and function between trapeziectomy and arthrodesis. Arthrodesis was associated with a higher complication rate compared with trapeziectomy. Platelet-rich plasma injections had improved pain, function, and patient satisfaction outcomes compared with corticosteroid injections.

Conclusions

No surgical intervention was superior to the other for treating the first CMC joint osteoarthritis. Trapeziectomy remains the simplest and one of the most established surgical modalities with good long-term outcomes and acceptable side effect profiles. Platelet-rich plasma injections may be a useful alternative to corticosteroids in first CMC osteoarthritis.