手术治疗斜骨腕关节关节炎：随机研究的网络荟萃分析

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-05-22 DOI:10.1016/j.jhsg.2025.100737

Dimitris Challoumas MBBCh, FRCS , Ali Hamad MBChB , Varun Rana MBChB , Amit Putti MBBS, FRCS , Neal L. Millar FRCS, PhD

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引用次数: 0

摘要

目的：比较不同术式治疗TMCJ关节炎的疗效和安全性。方法：我们对比较手术干预治疗TMCJ关节炎的随机研究进行了系统回顾和网络荟萃分析。我们的主要结局是患者报告的疼痛，次要结局是患者报告的功能障碍、关键捏力和并发症。计算连续结局的平均差异（MD）和标准化平均差异（SMD），计算二分类结局的优势比（OR），均为95%置信区间。结果共纳入21项随机研究。在两两荟萃分析中，与单纯梯形切除术联合韧带重建和肌腱介入（LRTI）的梯形切除术相比，所有疼痛、功能残疾和关键捏紧强度都相似(疼痛视觉模拟量表，MD为0.22分[- 0.66至0.21]；功能障碍，SMD为0.17[−0.06 ~ 0.41]；键夹紧强度，MD = 0.07 kg [- 0.22 ~ 036], P = 0.64)。与梯形切除术（有或没有LRTI）相比，全关节置换术提供了相似的短期疼痛缓解（MD 0.20分[−0.10至0.50]，证据确定性中等），在短期功能残疾（手臂、肩膀和手的残疾）和关键捏力(手臂、肩膀和手的功能残疾，MD 5.24分[0.72-9.75]，证据确定性低，统计学上有更大的改善；键夹紧强度，MD为0.92 kg[0.63, -1.21]，证据确定性中等])。仅键捏强度差异超过临床意义。在网络荟萃分析中，全关节置换术在所有短期疼痛、功能和关键捏紧强度方面排名第一；但其优势仅体现在关键捏紧强度上。单纯梯形切除术与LRTI梯形切除术、梯形切除术与全关节置换术的短期并发症相似；但是，没有长期的数据。结论全关节置换术在缓解疼痛和功能障碍方面至少与梯形切除术一样有效，在短期内关键捏紧强度方面可能优于梯形切除术。在从高质量的比较研究中获得长期疗效、并发症和生存数据之前，不建议广泛使用。研究类型/证据水平：治疗性II。

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Surgery for Trapeziometacarpal Joint Arthritis: A Network Meta-Analysis of Randomized Studies

Purpose

Our aim was to compare the efficacy and safety of the available surgical interventions for trapeziometacarpal joint (TMCJ) arthritis.

Methods

We conducted a systematic review and network meta-analysis of randomized studies comparing surgical interventions for TMCJ arthritis. Our primary outcome was patient-reported pain, and secondary outcomes were patient-reported functional disability, key pinch strength, and complications. Mean differences (MD) and standardized mean differences (SMD) were calculated for continuous outcomes and odds ratios (OR) for dichotomous outcomes, all with 95% confidence intervals.

Results

Twenty-one randomized studies were included. In pairwise meta-analyses, when simple trapeziectomy was compared with trapeziectomy with ligament reconstruction and tendon interposition (LRTI), all pain, functional disability, and key pinch strength were similar (pain visual analogue scale, MD 0.22 points [−0.66 to 0.21]; functional disability, SMD 0.17 [−0.06 to 0.41]; key pinch strength, MD 0.07 kg [−0.22 to 036], P = .64). Compared with trapeziectomy (with or without LRTI), total joint arthroplasty provided similar short-term pain relief (MD 0.20 points [−0.10 to 0.50], moderate certainty of evidence), statistically greater improvement in short-term functional disability (disabilities of the arm, shoulder, and hand), and key pinch strength (function disabilities of the arm, shoulder, and hand, MD 5.24 points [0.72–9.75], low certainty of evidence; key pinch strength, MD 0.92 kg [0.63,–1.21], and moderate certainty of evidence]). Only the difference in key pinch strength exceeded clinical significance. In network meta-analyses, total joint arthroplasty ranked first for all short-term pain, function, and key pinch strength; however, its superiority over other treatments was only significant for key pinch strength. Short-term complications between simple trapeziectomy and trapeziectomy with LRTI, and between trapeziectomy and total joint arthroplasty were similar; however, longer-term data were not available.

Conclusions

Total joint arthroplasty appears to be at least as effective as trapeziectomy for pain relief and functional disability and may be superior for key pinch strength in the short-term. Until long-term efficacy, complication, and survivorship data arising from high-quality comparative studies become available, its widespread use cannot be recommended.