Long-Term Outcomes in Female Patients With Carpometacarpal Arthroplasty and Metacarpophalangeal Fusion Compared With the Unoperated Side or Carpometacarpal Arthroplasty

IF 2.1 2区医学 Q2 ORTHOPEDICS Journal of Hand Surgery-American Volume Pub Date : 2025-03-01 DOI:10.1016/j.jhsa.2023.09.002

Carissa C. Dock BS , Rebecca Stone McGaver MS, ATC , Clare K. McCarthy MD

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Abstract

Purpose

Patients with carpometacarpal (CMC) osteoarthritis (OA) often present with metacarpophalangeal (MP) hyperextension and/or thenar atrophy. This study hypothesizes that MP fusion (MPF) performed at the time of CMC arthroplasty (CMCA) for patients who have moderate-to-severe thenar atrophy, MP hyperextension >30°, or MP arthritis will have greater long-term pinch strength and improvements in the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score from preoperative values when compared with the unoperated side or those who had CMCA only.

Methods

This study involved a retrospective review of long-term results from patients who underwent either CMCA or CMCA/MPF. The QuickDASH score, the pain visual analog scale (VAS), and an average of three pinch readings from each thumb were measured on the Baseline pinch gauge and recorded with a correction for hand dominance in right-handed patients.

Results

Fifty-three female patients with 70 operated thumbs were included in the study. The mean age was 67.2 years. There were 29 CMCAs and 41CMCA/MPFs. The mean follow-up was 6.3 years (range 2–16.9 years). At the latest follow-up, the mean CMCA/MPF pinch strength (11.3 lbs) was significantly stronger than that of CMCA (8.0 lbs) and carpometacarpal osteoarthritis thumbs (8.9 lbs). There was no significant difference in pinch strength between patients who underwent a CMCA and CMCOA thumbs (8.0 lbs vs 8.9 lbs, respectively). Preoperative QuickDASH demonstrated worse function in the CMCA/MPF group (55.8 vs 36.5). At the latest follow-up, QuickDASH and VAS revealed similar values in both the CMCA/MPF (10.5 and 0.66) and CMCA (18.5 and 0.52) groups.

Conclusion

Long-term results demonstrate stronger pinch and greater improvement in QuickDASH scores in patients who underwent CMCA/MPF compared with those who underwent a CMCA or untreated carpometacarpal osteoarthritis thumbs.

Type of study/level of evidence

Therapeutic IV.

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女性手掌骨置换术合并掌指骨融合术患者与未手术侧或手掌骨置换术患者的远期疗效比较。

目的：腕掌骨关节炎（OA）患者常表现为掌指（MP）过度伸展和/或鱼际萎缩。本研究假设，对于患有中度至重度鱼际萎缩、MP过度伸展>30°或MP关节炎的患者，在CMC关节成形术（CMCA）时进行的MP融合（MPF）将具有更大的长期握力，并改善手臂的快速残疾，与未手术侧或仅患有CMCA的患者相比，肩手（QuickDASH）评分来自术前值。方法：本研究对接受CMCA或CMCA/MPF的患者的长期结果进行了回顾性审查。在基线夹量表上测量QuickDASH评分、疼痛视觉模拟量表（VAS）和每个拇指的平均三个夹量读数，并对右手患者的手优势进行校正。结果：53名女性患者，70个拇指接受了手术。平均年龄67.2岁。共有29个CMCA和41个CMCA/MPF。平均随访时间为6.3年（2-16.9年）。在最近的随访中，CMCA/MPF的平均夹持力（11.3磅）明显强于CMCA（8.0磅）和腕掌骨关节炎拇指（8.9磅）。接受CMCA和CMCOA拇指的患者之间的握力没有显著差异（分别为8.0磅和8.9磅）。术前QuickDASH在CMCA/MPF组中表现出较差的功能（55.8 vs 36.5）。在最新的随访中，QuickDASH和VAS在CMC A/MPF（10.5和0.66）组和CMC A（18.5和0.52）组中显示出相似的值。结论：长期结果表明，与接受CMCA或未经治疗的腕掌骨关节炎拇指患者相比，接受CMCA/MPF的患者的QuickDASH评分有更大的改善。研究类型/证据水平：治疗IV。

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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.