Linscheid R L
Department of Orthopedic Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
J Hand Surg Am. 2000 Sep;25(5):796-816. doi: 10.1053/jhsu.2000.4166.
Small joint arthroplasty has lagged behind the development of that in large joints because of their small sizes, different shapes, presence within kinetic chains, complex soft tissue investments, presence of adjacent rays, secondary displacement and contracture, and the differing requirements of degenerative and rheumatoid arthritis. Prosthetic development must take into consideration range of motion, stability, tendon moment arms, fixation, ease of implantation, biocompatibility, wear and strength characteristics, and soft tissue reconstruction. The metacarpophalangeal, interphalangeal, and trapeziometacarpal joints each present different problems in the design of kinematic equivalent prostheses. One-piece polymeric designs have advantages in cost, adaptability, and known performance but show degradation of function with time. Total joint designs have the potential of better simulating normal joint function but have shown tendencies to subsidence, loosening, and breakage. The rigidity of hinge joints limits the damping of out-of-plane forces and places greater stress on bone-stem interfaces, whereas global designs have poor constraint features.
由于小关节尺寸小、形状各异、位于动力链中、软组织附着复杂、存在相邻指骨、继发移位和挛缩，以及退行性和类风湿性关节炎的不同需求，小关节置换术的发展落后于大关节。假体的研发必须考虑活动范围、稳定性、肌腱力臂、固定、植入的难易程度、生物相容性、磨损和强度特性以及软组织重建。掌指关节、指间关节和大多角骨-掌骨关节在运动等效假体的设计中各自存在不同问题。一体式聚合物设计在成本、适应性和已知性能方面具有优势，但随着时间推移功能会退化。全关节设计有更好地模拟正常关节功能的潜力，但已出现下沉、松动和断裂的趋势。铰链关节的刚性限制了平面外力的缓冲，并且在骨-柄界面处施加了更大的应力，而通用设计的约束特性较差。
