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Proximal row carpectomy generates better mid- to long-term outcomes than four-corner arthrodesis for post-traumatic wrist arthritis: A meta-analysis
Orthopaedics & Traumatology: Surgery & Research ( IF 2.3 ) Pub Date : 2022-08-05 , DOI: 10.1016/j.otsr.2022.103373
Pierre-Emmanuel Chammas 1 , Nawale Hadouiri 2 , Michel Chammas 3 , Sonia Ramos-Pascual 4 , Patrick Stirling 4 , Luca Nover 4 , Shahnaz Klouche 5
Affiliation  

Introduction

In posttraumatic wrist arthritis of intermediate severity, two main palliative procedures are used to preserve some mobility in the wrist: proximal row carpectomy (PRC) and scaphoid excision followed by four corner arthrodesis (4CA). Despite satisfactory overall results, the debate continues about which one provides the best results and long-term outcomes, particularly prevention of arthritis progression. Recent comparative studies now provide us with information about mid- and long-term results. The aim of this study was to compare the clinical results, complications, conversion rate to total wrist arthrodesis and progression to osteoarthritis of PRC versus 4CA in the medium and long term.

Hypothesis

The null hypothesis was that there is no significant difference between PRC and 4CA in the clinical results, complications, conversion to total wrist arthrodesis and arthritis progression.

Materials and methods

A systematic literature review was carried out by following the PRISMA guidelines. Included were studies comparing 4CA and PRC for the treatment of post-traumatic wrist arthritis secondary to scapholunate dissociation (SLAC) and scaphoid nonunion (SNAC) with a mean follow-up of 5 years. A search was performed of the MEDLINE, EMBASE and Cochrane databases that identified 831 articles. After removing 230 duplicates and excluding 595 articles based on their title and/or abstract, and then adding 1 article manually, 7 articles were included in our analysis. Parameters analyzed were range of motion (ROM), pain, grip strength, functional scores, complications, conversion to total wrist arthrodesis, and arthritis progression.

Results

In the 7 articles, 1059 wrists — 582 PRC and 477 4CA — were analyzed with follow-up ranging from 5.2 to 18 years. PRC produced significantly better ROM in flexion (weighted mean difference [WMD] = 10.0°; p < 0.01) and in ulnar deviation (WMD = 8.7°; p < 0.01) along with significantly lower complication rates (OR = 0.3; p < 0.01) and reoperation rates (OR = 0.1; p < 0.01). There was no significant difference in the conversion rate, grip strength, extension, radial deviation, pain, DASH and PRWE scores. The progression of osteoarthritis could not be analyzed due to lack of data.

Discussion

This meta-analysis was the first to include recently published mid- and long-term studies comparing PRC and 4CA. The main finding is that PRC is superior overall with better ROM and a lower complication rate. Another important finding was the absence of differences in grip strength and the conversion rate to total wrist arthrodesis. Unfortunately, the lack of systematic studies on arthritis progression leaves this question unanswered. Our findings must be interpreted cautiously because it was impossible to stratify the cases by etiology and osteoarthritis stage.

Level of evidence

III; systematic review and meta-analysis.



中文翻译:

对于创伤后腕关节炎,近排腕骨切除术比四角关节固定术产生更好的中长期结果:一项荟萃分析

介绍

在中等严重程度的创伤后腕关节炎中,两种主要的姑息性手术用于保持腕部的一些活动能力:近端腕骨切除术 (PRC) 和舟状骨切除术,然后进行四角关节固定术 (4CA)。尽管总体结果令人满意,但关于哪一种提供最佳结果和长期结果的争论仍在继续,尤其是预防关节炎进展。最近的比较研究现在为我们提供了有关中长期结果的信息。本研究的目的是比较中长期 PRC 与 4CA 的临床结果、并发症、转换为全腕关节固定术的转化率和进展为骨关节炎的情况。

假设

零假设是 PRC 和 4CA 在临床结果、并发症、转化为全腕关节固定术和关节炎进展方面没有显着差异。

材料和方法

按照 PRISMA 指南进行了系统的文献综述。包括比较 4CA 和 PRC 治疗继发于舟月骨分离 (SLAC) 和舟骨骨不连 (SNAC) 的创伤后腕关节炎的研究,平均随访 5 年。对 MEDLINE、EMBASE 和 Cochrane 数据库进行了搜索,确定了 831 篇文章。在删除 230 篇重复项并根据标题和/或摘要排除 595 篇文章,然后手动添加 1 篇文章后,我们的分析中包含 7 篇文章。分析的参数包括运动范围 (ROM)、疼痛、握力、功能评分、并发症、转为全腕关节固定术和关节炎进展。

结果

在这 7 篇文章中,对 1059 例手腕(582 例 PRC 和 477 例 4CA)进行了分析,随访时间为 5.2 至 18 年。PRC 在屈曲(加权平均差 [WMD]  =  10.0°;p  <  0.01)和尺偏(WMD  =  8.7°;p  <  0.01)中产生了明显更好的 ROM,同时并发症发生率显着降低(OR  =  0.3;p  <  0.01 ) 和再手术率 (OR  =  0.1; p  <  0.01)。转换率、握力、伸展、径向偏差、疼痛、DASH 和 PRWE 评分没有显着差异。由于缺乏数据,无法分析骨关节炎的进展。

讨论

该荟萃分析首次纳入了最近发表的比较 PRC 和 4CA 的中长期研究。主要发现是 PRC 总体上具有更好的 ROM 和更低的并发症发生率。另一个重要发现是握力和全腕关节固定术的转化率没有差异。不幸的是,缺乏对关节炎进展的系统研究使这个问题没有答案。必须谨慎解释我们的发现,因为不可能按病因学和骨关节炎分期对病例进行分层。

证据等级

三;系统评价和荟萃分析。

更新日期:2022-08-05
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