Nusem I, Goodwin D R
Department of Orthopaedics A, Tel-Aviv Sourasky Medical Center, Sakler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
J Hand Surg Br. 2003 Jun;28(3):242-5. doi: 10.1016/s0266-7681(03)00009-3.
Excision of the trapezium with Gelfoam interposition was performed in 35 thumbs, 34 of which were evaluated after an average 5 years. Twenty-four patients had unilateral procedures. The follow-up examination included a standardized questionnaire and clinical and radiological examinations. Pain relief was achieved in all cases. The patients considered that 32 of their operated hands had improved function, while two had not improved. All patients were satisfied with the final postoperative result. Adduction of the thumb to the index finger, and opposition to the tip of the little finger was possible in all cases. Weakness, in comparison to the other thumb, of lateral pinch (71%; P=0.0001), tip pinch (74%; P=0.007), and grip strength (85%; P=0.006) were observed. The first web span was preserved in all hands. Calculation of the trapezial space ratio demonstrated only slight, insignificant shortening (7%; P=0.06) of the thumb ray. No significant correlations between the postoperative trapezial space ratio and lateral pinch strength, tip pinch strength, and grip strength were observed. We conclude that excision of the trapezium and Gelfoam interposition has no specific complications and is a reliable surgical treatment for osteoarthritis of the trapeziometacarpal joint.
对35例拇指进行了带明胶海绵植入的大多角骨切除术，其中34例在平均5年后接受了评估。24例患者接受了单侧手术。随访检查包括标准化问卷以及临床和影像学检查。所有病例均实现了疼痛缓解。患者认为其32只接受手术的手功能得到改善，2只未改善。所有患者对最终术后结果均满意。所有病例中拇指均可内收至示指，并可与小指指尖对掌。与另一只拇指相比，观察到侧捏力（71%；P=0.0001）、指尖捏力（74%；P=0.007）和握力（85%；P=0.006）减弱。所有手部的第一掌骨间隙均得以保留。大多角骨间隙比率计算显示拇指列仅轻微缩短（7%；P=0.06），差异无统计学意义。未观察到术后大多角骨间隙比率与侧捏力、指尖捏力和握力之间存在显著相关性。我们得出结论，大多角骨切除和明胶海绵植入无特殊并发症，是治疗第一掌腕关节骨关节炎的可靠手术方法。
