Möller K, Sollerman C, Geijer M, Brånemark P I
Department of Hand Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
Acta Orthop Scand. 1999 Apr;70(2):109-15. doi: 10.3109/17453679909011245.
20 patients were operated on consecutively with osseointegrated MCP joint prostheses in 64 joints at our department between September 1993 and February 1995. The one-stage procedure included joint resection and cancellous bone grafting from the iliac crest before insertion of screw-shaped titanium fixtures, connected with a flexible silicone spacer. 18 patients (57 joints) were clinically and radiographically examined at median 28 (18-37) months postoperatively. Indications for surgery were joint destruction due to chronic arthritis in 17 patients (56 joints), and posttraumatic arthrosis in 1 patient (1 joint). Postoperative median range of motion was 40 (15-85) degrees, with an extension deficit of 30 (-20-70) degrees. 16 patients were satisfied, and had good pain relief and substantially improved postoperative hand function, evaluated with the standardized Sollerman hand function test. Radiographic osseointegration was obtained in 112 of 114 titanium fixtures (98%), but fracture of the silicone spacer was observed in 14 implants (25%). We conclude that osseointegration of longitudinal titanium fixtures in the bone marrow canal is possible in a one-stage procedure, but our findings show the need for a new, more durable joint spacer.
1993年9月至1995年2月期间，我们科室为20例患者的64个掌指关节连续实施了骨整合型人工关节置换手术。一期手术包括关节切除以及在植入螺旋形钛制固定装置前取自髂嵴的松质骨移植，该固定装置与一个柔性硅胶间隔器相连。18例患者（57个关节）在术后中位时间28（18 - 37）个月时接受了临床和影像学检查。手术指征为17例患者（56个关节）因慢性关节炎导致的关节破坏以及1例患者（1个关节）的创伤后关节病。术后中位活动范围为40（15 - 85）度，伸直受限为30（-20 - 70）度。16例患者表示满意，疼痛得到明显缓解，术后手部功能通过标准化的索勒曼手部功能测试评估有显著改善。114个钛制固定装置中有112个（98%）实现了影像学骨整合，但14个植入物（25%）观察到硅胶间隔器断裂。我们得出结论，在一期手术中，纵向钛制固定装置在骨髓腔内实现骨整合是可行的，但我们的研究结果表明需要一种新的、更耐用的关节间隔器。
