手部治疗是否会延迟拇指手掌骨关节炎的手术治疗?

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume Pub Date : 2025-02-01 DOI:10.1016/j.jhsa.2023.05.019

Daniel A. Portney MD , Quinn A. Stillson BS , Jason A. Strelzow MD , Jennifer Moriatis Wolf MD, PhD

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引用次数: 0

摘要

目的:拇指腕掌骨关节炎(CMC)引起功能性残疾，并增加老年人的医疗负担。治疗在拇指CMC OA中的作用在文献中很少被分析。我们假设，接受拇指CMC OA治疗的患者会降低这种诊断的手术率。方法:我们查询了一个国家保险数据集，查询了所有患有《国际疾病分类第九版》或《国际疾病统计分类第十版》拇指CMC OA代码的患者，随访时间至少为2年。创建了一个2:1倾向匹配的未接受治疗的CMC OA患者与接受治疗的患者队列，其中至少包括两次手部治疗。主要观察指标为诊断后2年内拇指CMC OA手术发生率;手术时间和拇指CMC注射的使用是次要结果。采用多变量logistic回归分析确定手术治疗的危险因素。结果:匹配后，治疗组包括14,548例患者，匹配组有28,930例未接受治疗的患者。在整个样本中，2年内手术率为22.5%。未接受治疗的患者的两年手术治疗率明显高于接受治疗的患者(29.3% vs 13.1%)。接受治疗的患者手术时间明显延长，一年后手术率无差异。在所有纳入变量的多变量回归中，缺乏治疗干预的拇指CMC OA手术的几率最高(优势比4.3)。结论:我们提出了一个大型保险数据库的研究结果，评估了治疗与拇指CMC关节炎手术治疗率的关系。平均而言，接受治疗的患者手术时间更长，诊断为拇指CMC关节炎的患者的2年手术率明显高于未接受治疗的患者。研究类型/证据水平:预后II。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Is Hand Therapy Associated With a Delay in Surgical Treatment in Thumb Carpometacarpal Arthritis?

Purpose

Thumb carpometacarpal (CMC) osteoarthritis (OA) causes functional disability and an increased health care burden in the aging population. The role of therapy in thumb CMC OA has been minimally analyzed in the literature. We hypothesized that patients treated with therapy for thumb CMC OA would demonstrate reduced rates of surgery for this diagnosis.

Methods

We queried a national insurance dataset for all patients with an International Classification of Diseases, Ninth Revision, or International Statistical Classification of Diseases, Tenth Revision, code for thumb CMC OA, with a minimum of 2 years of follow-up. A 2:1 propensity-matched cohort of patients with CMC OA who did not receive therapy versus a therapy cohort was created, with a minimum of two sessions of hand therapy for inclusion. The primary outcome was the rate of thumb CMC OA surgery occurring within 2 years of diagnosis; time to surgery and use of thumb CMC injections were secondary outcomes. Multivariable logistic regression analysis was used to identify the risk factors for undergoing surgical treatment.

Results

After matching, the therapy cohort comprised 14,548 patients, with a matched group of 28,930 patients who did not undergo therapy. In the overall sample, the rate of surgery within 2 years was 22.5%. Two-year surgical treatment rates were significantly higher for those who did not undergo therapy when compared with those who did (29.3% vs 13.1%). Patients treated with therapy had a significantly longer time to surgery, with no difference in the rate of surgery after one year. In multivariable regression of all included variables, lack of therapy intervention had the highest odds of surgery for thumb CMC OA (odds ratio 4.3).

Conclusions

We present the findings of a large insurance database evaluating the association of therapy with rates of surgical treatment for thumb CMC arthritis. On average, those treated with therapy had longer times to surgery, and the 2-year surgery rates for patients diagnosed with thumb CMC arthritis were significantly higher in those who did not undergo therapy treatment.

Type of study/level of evidence

Prognostic II.

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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.