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A Changing Landscape in Surgical Treatment of Basilar Thumb Arthritis: Is the Rate of Denervation Increasing?
IF 2.1 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-05 DOI: 10.1016/j.jhsa.2024.12.007
Daniel A Portney, Cody P Lee, Jennifer M Wolf, Jason A Strelzow, Jeffrey G Stepan

Purpose: The purpose of this study was to assess the evolving landscape of surgical interventions for basilar thumb arthritis.

Methods: Using a national insurance claims database spanning from 2016 to 2022, patients undergoing surgical treatment for thumb carpometacarpal (CMC) arthritis were identified through International Classification of Disease 10 and Current Procedural Terminology codes. The incidence of each type of surgical procedure was collected and normalized to the 2016 level. The total percentage change in incidence and linear regression trendline was calculated over the 7-year period. Multiple variable logistic regression assessed factors associated with thumb CMC denervation.

Results: Among 64,281 surgically treated patients, trapeziectomy with interposition arthroplasty was the most common (83.8%). Although thumb CMC denervation was the least common surgery and accounted for only 1.0% of all surgery, the incidence of denervation increased over the study period from 0.47 to 1.30 per 1,000,000, alongside a 41% rise in trapeziectomy alone. Regression analysis revealed male sex, Western US region, and concomitant carpal tunnel syndrome as associated factors for thumb CMC denervation.

Conclusions: The study indicates a notable shift in surgical approaches for basilar thumb arthritis. Although CMC denervation was the least commonly performed basal joint surgery, there was an increase in denervation procedures from 2016 to 2022. Denervation was not associated with patient age and was most strongly associated with male sex.

Type of study/level of evidence: Therapeutic IV.

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引用次数: 0
Solid Waste and Associated Environmental Impact of WALANT Carpal Tunnel Release Performed Across Three Clinical Settings.
IF 2.1 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-04 DOI: 10.1016/j.jhsa.2025.01.003
Audrey Le, Stephen Douglas, Jordan Baker, David Megee, Matthew Drake, Charles C Jehle

Purpose: Carpal tunnel release (CTR) remains the most common hand and wrist surgery in the United States, with an estimated 500,000 procedures per year. The introduction of wide-awake local anesthetic, no tourniquet (WALANT) technique and use of a minor sterile field has allowed CTR procedures to be performed in a clinic setting. Our study aimed to quantify the solid waste and related emissions associated with WALANT CTR procedures performed in a hospital operating room, ambulatory surgical center, and clinic.

Methods: All WALANT unilateral CTRs performed by three fellowship-trained hand surgeons from the same hospital system were prospectively studied over a 6-month period. Data gathered were surgical venue (hospital operating room, ambulatory surgical center (ASC), or clinic) and weight of solid waste produced by material type. The carbon emissions associated with the production and disposal of this waste were calculated using emissions factors from the UK Government's Department for Energy Security and Net Zero.

Results: Over 43 cases, there were significant differences in solid waste production. The average waste generated was 4.6 kg in the hospital operating room, 2.6 kg in the ASC, and 0.7 kg in the clinic. Similarly, greenhouse gas emissions, denoted in equivalent amount of CO2 (kgCO2-eq) varied by site, with the operating room emitting 41.6 kg of CO2eq, the ASC 26.0 kg, and the clinic 8.3 kg on average.

Conclusions: Our research considers the environmental impact of the same procedure performed in different settings. Under our institution's current policies, the clinic setting is the most sustainable venue to perform CTR. This supports and replicates previous studies at other institutions.

Clinical relevance: Limiting the environmental impact of surgery is possible. Moving common hand surgeries such as CTR to the clinic may be a more efficient way to achieve improvements in environmental impact than changing hospital or ASC policies.

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引用次数: 0
Does Perioperative Antibiotic Administration Decrease the Incidence of Prosthetic Joint Infection in Patients Undergoing Elective Soft Tissue Hand Surgery?
IF 2.1 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-04 DOI: 10.1016/j.jhsa.2025.01.002
Kelsey Young, Thompson Zhuang, Sophia Mavrommatis, Mitchell Hallman, Viviana Serra-Lopez, Ellis Berns, Andrew D Sobel

Purpose: The use of prophylactic antibiotics in patients with existing total hip or knee arthroplasty undergoing elective hand surgery has not been studied. We tested the null hypothesis that perioperative antibiotic administration is not associated with the incidence of prosthetic joint infection (PJI) in patients undergoing elective, soft tissue hand surgery.

Methods: We used a large, national administrative claims database to identify patients with existing total hip or knee arthroplasty undergoing soft tissue hand surgery (carpal tunnel release, de Quervain release, trigger finger release, limited palmar fasciectomy, ganglion or mucoid cyst removal, or soft tissue mass removal). Antibiotic prophylaxis was defined as the same day administration of intravenous cefazolin, vancomycin, or clindamycin. Patients receiving antibiotics were propensity score-matched in a 1:1 ratio to those who did not, accounting for age, sex, geographic region, insurance plan, subsequent surgeries, and the presence of comorbid diabetes mellitus, rheumatoid arthritis, myocardial infarction, congestive heart failure, chronic kidney disease, human immunodeficiency virus infection, chronic kidney disease, malignancy, obesity, or tobacco use. Residual differences between matched cohorts were adjusted for using multivariable logistic regression. The primary outcome was the incidence of PJI within 6, 9, and 12 months after hand surgery.

Results: The overall incidence of PJI was 0.8% (166/21,582) within 12 months after hand surgery. There was no difference in the incidence of PJI between patients who received antibiotic prophylaxis and those who did not at 6 (0.3% vs 0.5%), 9 (0.6% vs 0.7%), or 12 months (0.7% vs 0.8%) after hand surgery. These findings were unchanged after adjusting for residual confounding. Surgical site infection within 3 months after hand surgery was also not associated with PJI at 6, 9, or 12 months.

Conclusions: We found no association between prophylactic antibiotic administration in patients with prior total hip or knee arthroplasty undergoing soft tissue hand surgery and the incidence of PJI at 6, 9, and 12 months after surgery.

Type of study/level of evidence: Prognostic II.

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引用次数: 0
Efficacy of a Modified Bilhaut-Cloquet Procedure Using a Neurovascular Island Flap for Treatment of Radially Deviated Thumb Polydactyly With Hypoplasia. 使用神经血管岛皮瓣的改良 Bilhaut-Cloquet 程序治疗桡侧偏斜伴发育不良的拇指多指症的疗效。
IF 2.1 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-03 DOI: 10.1016/j.jhsa.2024.10.020
Sheng Cheng, Guangyao Li, Xianhui Ma, Weiyang Gao, Jian Ding, Anyuan Wang

Purpose: Baek's modified Bilhaut-Cloquet procedure is indicated for patients with symmetric bifid thumbs in Wassel type II or III polydactyly. The radially deviated type of thumb polydactyly with asymmetric bifid thumbs was previously contraindicated for this procedure. The objective of the study was to describe the results of our modified Bilhaut-Cloquet procedure using a neurovascular island flap of the radial duplicate for radially deviated type of thumb polydactyly with hypoplasia.

Methods: Twelve thumbs of 12 patients with a radially deviated type of thumb polydactyly underwent our modified Bilhaut-Cloquet procedure using a neurovascular island flap of the radial duplicate and were followed up for an average of 38.4 months. Functional and cosmetic assessments were made using the Japanese Society for Surgery of the Hand scoring system.

Results: All neurovascular island flaps survived, and the thumb size was restored close to that of the unaffected contralateral side in all cases. According to the Japanese Society for Surgery of the Hand scoring system, 8 cases achieved good results, and 4 achieved fair results. In terms of functional and aesthetic results, all cases were considered acceptable by the patient's parents.

Conclusions: Our technique using a neurovascular island flap of the radial duplicate in conjunction with the modified Bilhaut-Cloquet procedure was effective for the treatment of radially deviated type of thumb polydactyly with hypoplasia. This technique is an option for the treatment of radially deviated type of thumb polydactyly with hypoplasia.

Type of study/level of evidence: Therapeutic IV.

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引用次数: 0
Biomechanical Comparison of Suture Caliber and Number of Passes in Epitendinous Repair.
IF 2.1 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-02 DOI: 10.1016/j.jhsa.2024.11.021
David Cardenas, Anca Dogaroiu, Muhammad Harirah, Andrew Y Zhang, Andrei Odobescu, Douglas M Sammer

Purpose: The epitendinous suture is a critical part of flexor tendon repair. In addition to smoothing the repair site, it augments repair strength and increases gap resistance. This study aimed to determine whether increasing the number of passes or increasing suture caliber would improve the strength (primary outcome), 2 mm gap resistance, or stiffness of a simple running epitendinous suture.

Methods: A total of 30 flexor pollicis longus (FPL), flexor digitorum profundus (FDP), and flexor digitorum superficialis (FDS) tendons were harvested from three cadavers, and transverse tendon lacerations were produced. Tendons were repaired with only an epitendinous suture (no core suture) in three groups: 6-0 Prolene with six passes, 5-0 Prolene with six passes, or 5-0 Prolene with six passes. Epitendinous repair strength was tested using a materials testing machine.

Results: The use of eight passes had significantly greater ultimate tensile strength than six passes (21 +/- 7 N vs 14 +/- 5 N). Although 5-0 suture had a higher average ultimate tensile strength than 6-0 suture, this difference was not statistically significant (14 N +/- 5 vs 10 N +/- 3). Failure mode for all groups was most often suture tear-through.

Conclusions: A simple epitendinous suture using eight passes provides almost 50% more epitendinous repair strength and greater 2 mm gap resistance than six passes when using 5-0 Prolene.

Clinical relevance: When performing a simple running epitendinous repair to augment a core flexor tendon repair, the surgeon should consider the additional strength and gap resistance provided by eight passes compared to six.

目的:表腱缝合线是屈肌腱修复的关键部分。除了平滑修复部位外,它还能增强修复强度并提高间隙阻力。本研究旨在确定增加缝合次数或增大缝合线口径是否能提高简单跑动表腱缝合线的强度(主要结果)、2 毫米间隙阻力或硬度:方法:从三具尸体上共采集了 30 条膝屈肌(FPL)、趾屈肌(FDP)和趾浅屈肌(FDS)肌腱,并制作了横向肌腱裂口。只用表腱缝合线(无核心缝合线)修复肌腱,分为三组:6-0 Prolene 缝合六针、5-0 Prolene 缝合六针或 5-0 Prolene 缝合六针。使用材料试验机测试了表腱修复强度:结果:使用八道缝合线的极限拉伸强度明显高于六道缝合线(21 +/- 7 N vs 14 +/- 5 N)。虽然 5-0 缝线的平均极限拉伸强度高于 6-0 缝线,但这一差异在统计学上并不显著(14 N +/- 5 vs 10 N +/-3)。所有组别的失效模式最常见的是缝线撕裂:结论:与使用 5-0 Prolene 缝线的六次缝合相比,使用八次的简单外腱膜缝合可增加近 50% 的外腱膜修复强度和更大的 2 mm 间隙阻力:临床相关性:在进行简单的跑动式表腱缝合以增强核心屈肌腱修复时,外科医生应考虑八次缝合比六次缝合所提供的额外强度和间隙阻力。
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引用次数: 0
Journal CME Questions
IF 2.1 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 DOI: 10.1016/j.jhsa.2024.12.020
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引用次数: 0
MRI for Scaphoid Nonunion: Utilization Rates, Factors Associated With Utilization, and Subsequent Vascularized Bone Graft Use 舟状骨不连的MRI诊断:使用率、相关因素及后续血管化骨移植的使用。
IF 2.1 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 DOI: 10.1016/j.jhsa.2024.10.008
Lauren M. Shapiro MD, MS , Emily A. Schultz BS , Jessica Welch BS , Thompson Zhuang MD, MBA , Robin N. Kamal MD, MBA

Purpose

The use of magnetic resonance imaging (MRI) for evaluation of scaphoid nonunion may be an example of low-value imaging for the treatment of scaphoid nonunion. The purpose of this study was to investigate variation in MRI use for scaphoid nonunion, the association of MRI with a vascularized bone graft (VBG) and to develop consensus on MRI use for scaphoid nonunion.

Methods

We identified patients >18 years of age who underwent scaphoid nonunion surgery between 2010 and 2019 using a claims database. Patients who had, and did not have, an MRI within 90 days prior to their diagnosis of scaphoid nonunion were included and a multivariable analysis was performed to evaluate variation in MRI and VBG use. Subsequently, a literature review was performed, and a preliminary consensus statement was developed pertaining to the routine use of MRI for scaphoid nonunion. A consortium of nine hand surgeons evaluated the importance, feasibility, usability, and scientific acceptability of the statement through a modified RAND Coroporation/University of California, Los Angeles Delphi. Panelists evaluated the statement in two voting rounds with an intervening face-to-face discussion.

Results

We identified 1,324 eligible patients with surgical repair of a scaphoid nonunion. Two hundred and sixty-three (19.9%) underwent an MRI within 90 days prior to surgery. Differences in age, insurance type, and comorbidity burden existed between patients who received MRI and those who did not. The MRI cohort was more likely to receive VBG (10.6%) compared to those without an MRI (4.7%). Panelists agreed on the voting domains of the consensus statement and therefore the statement, “There is no benefit of routine MRI/MRA in the treatment of scaphoid nonunion with or without presumed avascular necrosis,” was considered valid.

Conclusions

MRI use within 90 days of surgical repair of scaphoid nonunion varies, is associated with greater rates of VBG use, and may represent low-value imaging given the lack of sufficient evidence on this topic.

Clinical relevance

As MRI use for scaphoid nonunion varies and may represent low-value imaging, a validated consensus statement may help guide the evaluation of patients with scaphoid nonunion.
目的:使用磁共振成像(MRI)评估舟状骨不连可能是治疗舟状骨不连的低价值成像的一个例子。本研究的目的是探讨MRI在舟状骨不愈合中的应用变化,MRI与血管化骨移植物(VBG)的关系,并就MRI在舟状骨不愈合中的应用达成共识。方法:我们使用索赔数据库确定了2010年至2019年期间接受舟状骨不愈合手术的年龄在18岁至18岁之间的患者。在舟状骨不连诊断前90天内进行或未进行MRI检查的患者被纳入研究,并进行多变量分析以评估MRI和VBG使用的变化。随后,我们进行了文献回顾,并就常规使用MRI检查舟状骨不连形成了初步共识。一个由九名手外科医生组成的联盟通过兰德公司/加州大学洛杉矶分校的德尔菲改进版评估了该声明的重要性、可行性、可用性和科学可接受性。小组成员在两轮投票中对声明进行了评估,其间进行了面对面的讨论。结果:我们确定了1324例符合条件的舟状骨不连手术修复患者。263例(19.9%)患者在手术前90天内接受了MRI检查。接受MRI和未接受MRI的患者在年龄、保险类型和合并症负担方面存在差异。与未做MRI的患者(4.7%)相比,MRI组更容易出现VBG(10.6%)。小组成员就共识声明的投票范围达成一致,因此,“常规MRI/MRA在治疗舟状骨不连(伴或不伴推定的缺血性坏死)中没有益处”的声明被认为是有效的。结论:舟状骨不连手术修复后90天内的MRI使用情况不同,与VBG使用率较高相关,由于缺乏足够的证据,可能代表低价值的成像。临床相关性:由于MRI用于舟状骨不连的方法各不相同,可能代表低价值成像,因此经过验证的共识声明可能有助于指导对舟状骨不连患者的评估。
{"title":"MRI for Scaphoid Nonunion: Utilization Rates, Factors Associated With Utilization, and Subsequent Vascularized Bone Graft Use","authors":"Lauren M. Shapiro MD, MS ,&nbsp;Emily A. Schultz BS ,&nbsp;Jessica Welch BS ,&nbsp;Thompson Zhuang MD, MBA ,&nbsp;Robin N. Kamal MD, MBA","doi":"10.1016/j.jhsa.2024.10.008","DOIUrl":"10.1016/j.jhsa.2024.10.008","url":null,"abstract":"<div><h3>Purpose</h3><div>The use of magnetic resonance imaging (MRI) for evaluation of scaphoid nonunion may be an example of low-value imaging for the treatment of scaphoid nonunion. The purpose of this study was to investigate variation in MRI use for scaphoid nonunion, the association of MRI with a vascularized bone graft (VBG) and to develop consensus on MRI use for scaphoid nonunion.</div></div><div><h3>Methods</h3><div>We identified patients &gt;18 years of age who underwent scaphoid nonunion surgery between 2010 and 2019 using a claims database. Patients who had, and did not have, an MRI within 90 days prior to their diagnosis of scaphoid nonunion were included and a multivariable analysis was performed to evaluate variation in MRI and VBG use. Subsequently, a literature review was performed, and a preliminary consensus statement was developed pertaining to the routine use of MRI for scaphoid nonunion. A consortium of nine hand surgeons evaluated the importance, feasibility, usability, and scientific acceptability of the statement through a modified RAND Coroporation/University of California, Los Angeles Delphi. Panelists evaluated the statement in two voting rounds with an intervening face-to-face discussion.</div></div><div><h3>Results</h3><div>We identified 1,324 eligible patients with surgical repair of a scaphoid nonunion. Two hundred and sixty-three (19.9%) underwent an MRI within 90 days prior to surgery. Differences in age, insurance type, and comorbidity burden existed between patients who received MRI and those who did not. The MRI cohort was more likely to receive VBG (10.6%) compared to those without an MRI (4.7%). Panelists agreed on the voting domains of the consensus statement and therefore the statement, “There is no benefit of routine MRI/MRA in the treatment of scaphoid nonunion with or without presumed avascular necrosis,” was considered valid.</div></div><div><h3>Conclusions</h3><div>MRI use within 90 days of surgical repair of scaphoid nonunion varies, is associated with greater rates of VBG use, and may represent low-value imaging given the lack of sufficient evidence on this topic.</div></div><div><h3>Clinical relevance</h3><div>As MRI use for scaphoid nonunion varies and may represent low-value imaging, a validated consensus statement may help guide the evaluation of patients with scaphoid nonunion.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 2","pages":"Pages 182-187"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Is Hand Therapy Associated With a Delay in Surgical Treatment in Thumb Carpometacarpal Arthritis? 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 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

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.
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。
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引用次数: 0
2024 ASSH Presidential Address: Making Space
IF 2.1 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 DOI: 10.1016/j.jhsa.2024.11.003
Steven L. Moran MD
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引用次数: 0
Reliability and Validity of the Ten Test for the Assessment of Digit Sensation.
IF 2.1 2区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 DOI: 10.1016/j.jhsa.2024.12.015
Yagiz Ozdag, Jessica L Koshinski, Anil Akoon, Victoria C Garcia, C Liam Dwyer, Joel C Klena, Louis C Grandizio

Purpose: The ten test (TT) is a sensory assessment used to quantify the sensation of each digit. Because it does not require additional equipment, it may have utility in telemedicine. Our purpose was to evaluate the validity and reliability of the TT.

Methods: Adult patients with nontrauma upper-extremity complaints were evaluated within an academic outpatient clinic. Two examiner groups (hand surgeons [group 1] and residents/physician assistants [group 2]) administered the TT and static two-point discrimination (2PD). Hand surgeons were blinded to the results obtained by the initial examiners. The TT is administered by having the patient define an area of normal sensation with their uninvolved index finger and then rate digital sensation against the involved hand on a 1-10 scale, with 10 defined as perfectly normal sensation. A cut-point analysis was employed, and both sensory assessments were categorized as either normal (2PD ≤5 mm, TT ≥9) or abnormal sensation for the entire median-nerve distribution and individual digit level. Agreement statistics including sensitivity (Sn) and specificity (Sp) were calculated for the TT, using static 2PD as the reference standard. Interrater reliability was compared between the groups of examiners.

Results: A total of 201 patients (1,005 digits) were examined. The Sn/Sp for the TT was 53%/84% and 54%/85% at the digit-level and median-nerve distribution level, respectively. Interrater reliability for the TT between the groups of examiners was substantial at the digit level (κ = 0.68, SE = 0.02).

Conclusions: The Sn/Sp for the TT was 53%/84% when using static 2PD as the reference standard. Interrater reliability for TT was substantial (κ = 0.68). The TT can serve as an alternative to other sensory assessments that require instrumentation. As telemedicine programs continue to evolve within upper-extremity surgery, the TT may be a useful tool with virtual applications.

Type of study/level of evidence: Diagnostic I.

目的:十位测试(TT)是一种感官评估方法,用于量化每个数字的感觉。由于它不需要额外的设备,因此在远程医疗中可能很有用。我们的目的是评估 TT 的有效性和可靠性:方法:在一家学术门诊中对上肢无创伤的成年患者进行评估。两组检查人员(手外科医生 [第 1 组] 和住院医师/医生助理 [第 2 组])分别进行 TT 和静态两点辨别 (2PD) 测试。手外科医生对初始检查者得出的结果视而不见。TT的测试方法是让患者用未受累的食指定义一个感觉正常的区域,然后用1-10分对受累手的数字感觉进行评分,10分为感觉完全正常。采用了切点分析法,两种感觉评估均被归类为正常(2PD ≤5 mm,TT ≥9)或整个正中神经分布和单个手指感觉异常。以静态 2PD 为参考标准,计算了 TT 的一致性统计,包括灵敏度 (Sn) 和特异度 (Sp)。比较了各组检查者之间的相互可靠性:共检查了 201 名患者(1,005 个数字)。在数位水平和中位神经分布水平上,TT 的 Sn/Sp 分别为 53%/84% 和 54%/85%。在数位水平上,两组检查者之间的TT互测可靠性非常高(κ = 0.68,SE = 0.02):以静态 2PD 作为参考标准时,TT 的 Sn/Sp 为 53%/84%。TT 的互测可靠性很高(κ = 0.68)。TT 可以替代其他需要仪器的感官评估。随着远程医疗项目在上肢外科领域的不断发展,TT可能会成为一种有用的虚拟应用工具:诊断 I。
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引用次数: 0
期刊
Journal of Hand Surgery-American Volume
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