{"title":"拇指尺侧副韧带损伤的手术治疗：614例患者至少1年随访的系统回顾和荟萃分析。","authors":"Adam Schumaier, Francine Zeng, Chris McCarthy","doi":"10.5435/JAAOSGlobal-D-25-00082","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Thumb ulnar collateral ligament (UCL) injuries are relatively common and may lead to pain and instability. Outcomes following surgical management have generally been acceptable, but data comparing techniques are limited. Furthermore, the optimal timeframe for surgery has not been established. The purpose of this systematic review and meta-analysis was to compare outcomes of different surgical techniques and timeframes for treating thumb UCL injuries.</p><p><strong>Methods: </strong>This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were analyzed based on the type of surgery performed: primary repair (PR) to soft tissue or bone tunnels, suture anchor repair (SAR) with or without internal brace, or reconstruction (REC) with autograft. A random effects model was used.</p><p><strong>Results: </strong>The analysis included 24 studies with 616 thumbs (PR = 146, SAR = 371, REC = 99). Average follow-up was 47 months. Average time from injury to surgery was 9.3 days (PR), 4.1 months (SAR), and 19.1 months (REC). The most commonly stated indication for surgery was lack of a firm end point on collateral stress testing. In the reconstruction group, all injuries were described as chronic or irreparable. A notable difference was found in the proportion of stable thumbs (PR 95%, SAR 95%, REC 81%) and return to unrestricted activities (PR 96%, SAR 93%, REC 84%). No clinically notable differences were observed in pain, grip strength, pinch strength, QuickDASH scores, return to work, complications, or complications requiring intervention.</p><p><strong>Conclusion: </strong>Surgical management of thumb UCL injuries produces overall favorable results. Acute, subacute, and repairable injuries treated with primary repair or suture anchor repair are more likely to be stable and allow unrestricted return to prior activities compared with chronic, irreparable injuries treated with reconstruction.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 5","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052237/pdf/","citationCount":"0","resultStr":"{\"title\":\"Surgical Management of Thumb Ulnar Collateral Ligament Injuries: A Systematic Review and Meta-analysis of 614 Patients With a Minimum 1 Year Follow-up.\",\"authors\":\"Adam Schumaier, Francine Zeng, Chris McCarthy\",\"doi\":\"10.5435/JAAOSGlobal-D-25-00082\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Thumb ulnar collateral ligament (UCL) injuries are relatively common and may lead to pain and instability. Outcomes following surgical management have generally been acceptable, but data comparing techniques are limited. Furthermore, the optimal timeframe for surgery has not been established. The purpose of this systematic review and meta-analysis was to compare outcomes of different surgical techniques and timeframes for treating thumb UCL injuries.</p><p><strong>Methods: </strong>This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were analyzed based on the type of surgery performed: primary repair (PR) to soft tissue or bone tunnels, suture anchor repair (SAR) with or without internal brace, or reconstruction (REC) with autograft. A random effects model was used.</p><p><strong>Results: </strong>The analysis included 24 studies with 616 thumbs (PR = 146, SAR = 371, REC = 99). Average follow-up was 47 months. Average time from injury to surgery was 9.3 days (PR), 4.1 months (SAR), and 19.1 months (REC). The most commonly stated indication for surgery was lack of a firm end point on collateral stress testing. In the reconstruction group, all injuries were described as chronic or irreparable. A notable difference was found in the proportion of stable thumbs (PR 95%, SAR 95%, REC 81%) and return to unrestricted activities (PR 96%, SAR 93%, REC 84%). No clinically notable differences were observed in pain, grip strength, pinch strength, QuickDASH scores, return to work, complications, or complications requiring intervention.</p><p><strong>Conclusion: </strong>Surgical management of thumb UCL injuries produces overall favorable results. Acute, subacute, and repairable injuries treated with primary repair or suture anchor repair are more likely to be stable and allow unrestricted return to prior activities compared with chronic, irreparable injuries treated with reconstruction.</p>\",\"PeriodicalId\":45062,\"journal\":{\"name\":\"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews\",\"volume\":\"9 5\",\"pages\":\"\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-05-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052237/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5435/JAAOSGlobal-D-25-00082\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/5/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5435/JAAOSGlobal-D-25-00082","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
背景：拇指尺侧副韧带（UCL）损伤相对常见，可导致疼痛和不稳定。手术治疗后的结果通常是可以接受的，但比较技术的数据有限。此外，手术的最佳时间框架尚未确定。本系统综述和荟萃分析的目的是比较不同手术技术和时间框架治疗拇指UCL损伤的结果。方法：本研究按照系统评价和荟萃分析指南的首选报告项目进行。数据根据手术类型进行分析：软组织或骨隧道的初级修复（PR），带或不带内支架的缝合锚修复（SAR），或自体移植物重建（REC）。采用随机效应模型。结果：纳入24项研究，共616根拇指（PR = 146, SAR = 371, REC = 99）。平均随访时间为47个月。从损伤到手术的平均时间为9.3天（PR）， 4.1个月（SAR）和19.1个月（REC）。最常见的手术指征是侧枝压力测试缺乏明确的终点。在重建组中，所有损伤都被描述为慢性或不可修复。在稳定拇指的比例（PR 95%, SAR 95%, REC 81%）和恢复无限制活动的比例（PR 96%, SAR 93%, REC 84%）方面存在显著差异。在疼痛、握力、捏紧力、QuickDASH评分、恢复工作、并发症或需要干预的并发症方面没有观察到临床显著差异。结论：拇指UCL损伤的手术治疗总体效果良好。与重建治疗的慢性、不可修复损伤相比，采用初级修复或缝合锚定修复治疗的急性、亚急性和可修复损伤更可能稳定，并可无限制地恢复先前的活动。
Surgical Management of Thumb Ulnar Collateral Ligament Injuries: A Systematic Review and Meta-analysis of 614 Patients With a Minimum 1 Year Follow-up.
Background: Thumb ulnar collateral ligament (UCL) injuries are relatively common and may lead to pain and instability. Outcomes following surgical management have generally been acceptable, but data comparing techniques are limited. Furthermore, the optimal timeframe for surgery has not been established. The purpose of this systematic review and meta-analysis was to compare outcomes of different surgical techniques and timeframes for treating thumb UCL injuries.
Methods: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were analyzed based on the type of surgery performed: primary repair (PR) to soft tissue or bone tunnels, suture anchor repair (SAR) with or without internal brace, or reconstruction (REC) with autograft. A random effects model was used.
Results: The analysis included 24 studies with 616 thumbs (PR = 146, SAR = 371, REC = 99). Average follow-up was 47 months. Average time from injury to surgery was 9.3 days (PR), 4.1 months (SAR), and 19.1 months (REC). The most commonly stated indication for surgery was lack of a firm end point on collateral stress testing. In the reconstruction group, all injuries were described as chronic or irreparable. A notable difference was found in the proportion of stable thumbs (PR 95%, SAR 95%, REC 81%) and return to unrestricted activities (PR 96%, SAR 93%, REC 84%). No clinically notable differences were observed in pain, grip strength, pinch strength, QuickDASH scores, return to work, complications, or complications requiring intervention.
Conclusion: Surgical management of thumb UCL injuries produces overall favorable results. Acute, subacute, and repairable injuries treated with primary repair or suture anchor repair are more likely to be stable and allow unrestricted return to prior activities compared with chronic, irreparable injuries treated with reconstruction.
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