Bettinger P C, Linscheid R L, Cooney W P, An K N
Orthopaedic Biomechanics Lab, Mayo Graduate School of Medicine, Mayo Clinic, Rochester, MN 59505, USA.
J Hand Surg Am. 2001 Jul;26(4):692-7. doi: 10.1053/jhsu.2001.26187.
Trapeziometacarpal (TMC) joint arthritis is a common and debilitating condition of the hand. We defined a radiographic measure of trapezial inclination (trapezial tilt) and found a positive correlation between an increased trapezial tilt and severity of TMC joint arthritis. Radiographs (Robert's views) were obtained from 50 pairs of normal hands to evaluate the trapezial tilt to assess radial inclination of the trapezium with respect to the second metacarpal. The trapezial tilt was also measured in 65 hands from 43 patients with various stages of TMC joint arthritis and compared with the normal value. The trapezial tilt for hands without arthritis was 42 degrees +/- 4 degrees, Eaton stages I and II was 42 degrees +/- 4 degrees, and Eaton stages III and IV was 50 degrees +/- 4 degrees. Trapezial tilt angles from the Eaton III and IV group were significantly greater than those of the normal and Eaton I and II groups. Advanced TMC joint arthritis (Eaton III and IV) is associated with an increased trapezial tilt. Mild TMC joint arthritis with an increased trapezial tilt may be treated surgically. We speculate that a trapezio-trapezoid and trapezio-II metacarpal arthrodesis, or an opening wedge osteotomy of the trapezium might arrest the progression of TMC joint arthritis by resetting the slope of the trapezium and decreasing the shear stress within the TMC joint.
大多角骨-第一掌骨（TMC）关节关节炎是一种常见且使人衰弱的手部疾病。我们定义了一种大多角骨倾斜度（大多角骨倾斜）的影像学测量方法，并发现大多角骨倾斜度增加与TMC关节关节炎的严重程度之间存在正相关。从50对正常手部获取X线片（罗伯特位），以评估大多角骨倾斜度，从而评估大多角骨相对于第二掌骨的桡侧倾斜度。还对43例处于TMC关节关节炎不同阶段的患者的65只手进行了大多角骨倾斜度测量，并与正常值进行比较。无关节炎手部的大多角骨倾斜度为42度±4度，伊顿I期和II期为42度±4度，伊顿III期和IV期为50度±4度。伊顿III期和IV期组的大多角骨倾斜角明显大于正常组以及伊顿I期和II期组。重度TMC关节关节炎（伊顿III期和IV期）与大多角骨倾斜度增加有关。大多角骨倾斜度增加的轻度TMC关节关节炎可能需要手术治疗。我们推测，大多角骨-大多角骨关节固定术和大多角骨-第二掌骨关节固定术，或大多角骨的开放楔形截骨术，可能通过重置大多角骨的斜率并降低TMC关节内的剪切应力来阻止TMC关节关节炎的进展。
