Takigawa Souichirou, Meletiou Steve, Sauerbier Michael, Cooney William P
Department of Orthopedics, Division of Hand Surgery, Mayo Clinic, Rochester, MN 55905, USA.
J Hand Surg Am. 2004 Sep;29(5):785-95. doi: 10.1016/j.jhsa.2004.03.008.
The purpose of this study was to evaluate the clinical results of Swanson silicone implant arthroplasty of the proximal interphalangeal (PIP) joint, specifically evaluating clinical results with long-term assessment.
A retrospective review of 70 silicone implants of the PIP joint in 48 patients was performed with an average follow-up period of 6.5 years (range, 3-20 y). Clinical assessment included motion, stability, and alignment. Radiographic assessment included implant fracture, deformity, and cystic bone resorption. The pathology consisted of degenerative joint disease in 14, posttraumatic arthritis (TA) in 11, rheumatoid arthritis (RA) in 13, and idiopathic arthritis (IA) associated with collagen disease in 12 patients. Swan neck and boutonniere deformities were assessed separately. Statistical analysis of preoperative risk factors was compared with the postoperative assessment of pain, motion, and function (return to work).
There was no significant change in the active range of motion (ROM) before and after PIP arthroplasty (26 degrees vs 30 degrees ). Correction of swan neck and boutonniere deformities was difficult, usually leading to poor results. There was improvement in maximum active extension before surgery lacking 32 degrees to after surgery lacking 18 degrees . From a statistical standpoint rheumatoid joint involvement with PIP arthroplasty had poorer results than degenerative or posttraumatic arthritis with respect to pain relief and ROM. Pain relief was present in 70% of replaced PIP joints with residual pain and loss of strength in 30%. Radiographic analysis showed abnormal bone formation (cystic changes) in 45%. There were 11 implant fractures and 9 joints that required revision surgery.
Silicone replacement of the PIP joint is effective in providing relief of pain from arthritis but does not provide improvement in motion or correction of deformity. It provided a poorer outcome in rheumatoid disease in comparison with degenerative, posttraumatic, or idiopathic arthritis.
本研究旨在评估近端指间（PIP）关节Swanson硅胶植入关节成形术的临床效果，特别是进行长期评估的临床效果。
对48例患者的70个PIP关节硅胶植入物进行回顾性研究，平均随访期为6.5年（范围3 - 20年）。临床评估包括活动度、稳定性和对线情况。影像学评估包括植入物骨折、畸形和囊性骨吸收。病理情况包括14例退行性关节病、11例创伤后关节炎（TA）、13例类风湿关节炎（RA）和12例与胶原病相关的特发性关节炎（IA）。分别评估鹅颈畸形和纽扣花样畸形。对术前危险因素进行统计分析，并与术后疼痛、活动度和功能（恢复工作）评估进行比较。
PIP关节成形术前、后主动活动范围（ROM）无显著变化（分别为26度和30度）。纠正鹅颈畸形和纽扣花样畸形困难，通常导致效果不佳。术前最大主动伸展度缺乏32度，术后缺乏18度，有改善。从统计学角度看，类风湿关节受累的PIP关节成形术在疼痛缓解和ROM方面的效果比退行性或创伤后关节炎差。70%的置换PIP关节疼痛缓解，30%有残留疼痛和力量丧失。影像学分析显示45%有异常骨形成（囊性改变）。有11例植入物骨折，9个关节需要翻修手术。
PIP关节硅胶置换术可有效缓解关节炎疼痛，但不能改善活动度或纠正畸形。与退行性、创伤后或特发性关节炎相比，其在类风湿疾病中的效果较差。
