梯形掌骨(TMC)骨关节炎的最佳治疗仍存在争议。这项荟萃分析评估了梯形掌骨关节固定术(TMA)与带韧带重建的梯形切除术(LRTI)的主观和客观结果。PubMed,科克伦图书馆,Embase,从开始到2022年6月30日搜索了WebofScience数据库。关键词包括“梯形掌骨骨关节炎”,“梯形掌骨关节固定术”和“带韧带重建的梯形切除术”。包括接受TMC骨关节炎治疗的患者的随机对照试验(RCT)和对照临床试验(CCT)。主观结果视觉模拟量表(VAS),患者额定腕部和手部评估(PRWHE),手臂残疾,肩和手(DASH)得分,卡潘吉得分,客观结果总指间(IP)和掌指关节(MCP)关节运动,手掌绑架,握力,tip,提取关键捏强度和并发症。各自的方法学质量进行独立评估。对比较试验进行Meta分析。从5项纳入的研究中(2项RCT,3个CCT),208例患者分为TMA组(n=107)和LRTI组(n=101)。与TMA组相比,PRWHEE,LRTI组的尖端捏合强度和手掌外展更好。DASH评分无统计学差异,VAS,Kapandji得分,握力,按键夹紧强度,总IP关节运动,MCP关节总运动和并发症。LRTI组在PRWHEE方面具有更明显的优势,尖端捏合强度和手掌外展。此外,DASH评分无统计学差异,VAS,Kapandji得分,握力,按键夹紧强度,总IP关节和总MCP关节运动和并发症。因此,我们的结论是LRTI对于TMC骨关节炎的更多治疗更值得推荐.当然,长期随访需要高质量的研究.
The optimal management of trapeziometacarpal (TMC) osteoarthritis remains controversial. This meta-analysis assessed the subjective and objective outcomes of trapeziometacarpal arthrodesis (TMA) versus trapeziec-tomy with ligament reconstruction (LRTI). The PubMed, Cochrane Library, Embase, Web of science data-bases were searched from inception to June 30, 2022. Keywords included \"trapeziometacarpal osteoarthrosis\", \"trapeziometacarpal arthrodesis\" and \"trapeziectomy with ligament reconstruction\". Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) including patients treated for TMC osteoarthritis were included. The subjective outcomes visual analogue scale (VAS) , Patient-Rated Wrist and Hand Evaluation (PRWHE), Disabilities of arm, shoulder and hand (DASH) scores, Kapanji scores, objective outcomes total interphalangeal (IP) and metacarpophalangeal (MCP) joint motion, palmar abduction, grip strength, tip, key pinch strength and complications were extracted. The methodological quality of each was assessed in- dependently. Meta-analysis was performed for comparative trials. From the 5 included studies (2 RCTs, 3 CCTs), 208 cases were divided into TMA group (n = 107) and LRTI group (n =101) groups. Compared with the TMA group, PRWHE, tip pinch strength and palmar abduction was better in the LRTI group. There was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint motion, total MCP joint motion and complications. The LRTI group had more obvious advantages in term of PRWHE, tip pinch strength and palmar abduction. Moreover, there was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint and total MCP joint motion and complications. Therefore, we concluded LRTI was more recommendable for more management of TMC osteoarthritis. Certainly, high-quality studies are required in long-term follow-up.