梯形掌骨关节骨关节炎(TMJO)影响高达33%的绝经后妇女,导致疼痛,流动性降低,和握力,最初的治疗侧重于注射等非手术选择,矫形器,在考虑手术之前进行锻炼。管理TMJO的主要挑战涉及选择针对个体临床状况定制的最佳手术策略。本研究旨在比较TMJO三种常见手术干预在缓解疼痛方面的有效性。包括关节镜清理术(AD),梯形切除术(TRAP),和关节置换(JR)。PubMed,科克伦,Embase,根据系统评价和荟萃分析的首选报告项目(PRISMA)指南,查询了MEDLINE数据库,该指南介绍了TMJO干预后的疼痛结局.使用视觉模拟量表(VAS)报告术前和术后的疼痛评分。纳入标准包括发表在Q1和Q2期刊上的研究以及随访时间>6个月的研究。最终选择包括18项研究,其中763例接受AD治疗的患者(n=102,13%),TRAP(n=428,56%),和JR(n=233,31%)在2010年至2023年之间,平均随访时间为38±28个月。研究共包括24组,其中五个收到了广告,其中13人收到了陷阱,其中六个收到了JR。术前平均VAS为6.7±1.7,术后平均VAS为1.7±1.3(P<0.001)。荟萃分析显示AD的术前平均疼痛评分为5.8(95%CI,4.1-7.5),陷阱为6.6(95%CI,5.7-7.5),JR为7.8(95%CI,7.0-8.7)。术后,AD的平均疼痛评分为2.2(95%CI,0.1-4.2),TRAP为1.4(95%CI,1.1-1.7),JR为0.9(95%CI,0.6-1.2)。这项研究表明,如果有适当的指示,在短期减轻与TMJO相关的疼痛方面,AD的关节保留可能与TRAP和JR一样有效.然而,在未来的研究中应评估转换或修订率.
Trapeziometacarpal joint osteoarthritis (TMJO) affects up to 33% of postmenopausal women, leading to pain, reduced mobility, and grip strength, with initial treatments focusing on non-surgical options like injections, orthoses, and exercises before considering surgery. A major challenge in managing TMJO involves selecting the optimal surgical strategy that is customized to individual clinical conditions. This study aimed to compare the effectiveness of three common surgical interventions for TMJO in relieving pain, including arthroscopic debridement (AD), trapeziectomy (TRAP), and joint replacement (JR). PubMed, Cochrane, Embase, and MEDLINE databases were queried according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies that presented pain outcomes following intervention for TMJO. Pain scores were reported preoperatively and postoperatively using the visual analog scale (VAS). Inclusion criteria included studies published in Q1 and Q2 journals and those with a follow-up of > six months. The final selection comprised 18 studies with 763 patients treated with AD (n = 102, 13%), TRAP (n = 428, 56%), and JR (n = 233, 31%) between 2010 and 2023, with a mean follow-up period of 38 ± 28 months. The studies included a total of 24 groups, five of which received AD, 13 of which received TRAP, and six of which received JR. The mean preoperative VAS was 6.7 ± 1.7, and the mean postoperative VAS was 1.7 ± 1.3 for all groups (P < 0.001). The meta-analysis demonstrated a mean preoperative pain score of 5.8 (95% CI, 4.1-7.5) for AD, 6.6 (95% CI, 5.7-7.5) for TRAP, and 7.8 (95% CI, 7.0-8.7) for JR. Postoperatively, there was a mean pain score of 2.2 (95% CI, 0.1-4.2) for AD, 1.4 (95% CI, 1.1-1.7) for TRAP, and 0.9 (95% CI, 0.6-1.2) for JR. This study showed that, if appropriately indicated, joint preservation with AD may be as effective as TRAP and JR for reducing pain associated with TMJO in the short term. However, the rate of conversion or revision should be assessed in future studies.