Rettig Lance A, Luca Linda, Murphy Michael S
Curtis National Hand Center, Union Memorial Hospital, Baltimore, MD 21218, USA.
J Hand Surg Am. 2005 Jul;30(4):667-72. doi: 10.1016/j.jhsa.2005.02.011.
The outcome of silicone metacarpophalangeal (MCP) joint implant arthroplasty in the osteoarthritic patient population has not been well established. Typically patients with idiopathic osteoarthritis have no history of underlying systemic disease and may respond well to treatment with MCP joint implant arthroplasty. This study examined the efficacy of silicone MCP joint implant arthroplasty for patients with idiopathic osteoarthritis for whom nonsurgical treatment had failed.
Of 14 patients (15 arthroplasties) who had silicone MCP joint implant arthroplasty for idiopathic osteoarthritis 12 (13 arthroplasties) returned for follow-up evaluation at an average of 40 months after surgery. There were 9 index finger and 4 middle finger arthroplasties. The average age at the time of surgery was 62 years. Patients completed a subjective questionnaire and were examined by a certified therapist. Range of motion and strength were recorded and the Jebsen-Taylor examination was administered to assess function. Range of motion values at final follow-up evaluation were compared with preoperative and early postoperative values. Radiographs were taken at final follow-up evaluation and compared with preoperative and early postoperative films to assess joint position, wear, and radioulnar alignment.
At final follow-up evaluation excellent (9 patients) and good (3 patients) overall improvement were reported. Nine patients (10 implants) reported greater than 75% functional improvement. A notable increase was seen in MCP joint flexion. Grip and lateral pinch strengths were below age-matched normative data. Of the 11 patients (12 implants) who came in for follow-up evaluation 7 performed all tasks of the Jebsen-Taylor examination within the allotted time. At final follow-up evaluation all silicone implants were located and showed no signs of subluxation. Radiographic radioulnar alignment was maintained. One implant was revised at 35 months secondary to fracture.
Silicone implant arthroplasty is a motion-sparing procedure that provides good pain relief and maintenance of function at intermediate follow-up evaluation in patients with idiopathic osteoarthritis of the MCP joint.
在骨关节炎患者群体中，硅酮掌指关节（MCP）置换术的效果尚未得到充分证实。典型的特发性骨关节炎患者无潜在系统性疾病史，可能对MCP关节置换术治疗反应良好。本研究探讨了硅酮MCP关节置换术对非手术治疗失败的特发性骨关节炎患者的疗效。
14例（15次置换）因特发性骨关节炎接受硅酮MCP关节置换术的患者中，12例（13次置换）在术后平均40个月返回进行随访评估。其中食指置换9例，中指置换4例。手术时的平均年龄为62岁。患者完成一份主观问卷，并由一名认证治疗师进行检查。记录活动范围和力量，并进行Jebsen-Taylor测试以评估功能。将最终随访评估时的活动范围值与术前和术后早期的值进行比较。在最终随访评估时拍摄X线片，并与术前和术后早期的片子进行比较，以评估关节位置、磨损和桡尺侧对线情况。
在最终随访评估中，报告了9例优秀和3例良好的总体改善情况。9例患者（10个植入物）报告功能改善超过75%。MCP关节屈曲明显增加。握力和侧捏力低于年龄匹配的正常数据。在前来进行随访评估的11例患者（12个植入物）中，7例在规定时间内完成了Jebsen-Taylor测试的所有任务。在最终随访评估时，所有硅酮植入物位置良好，未显示半脱位迹象。维持了X线片的桡尺侧对线。1个植入物在35个月时因骨折进行了翻修。
硅酮植入物置换术是一种保留运动的手术，在MCP关节特发性骨关节炎患者的中期随访评估中，能有效缓解疼痛并维持功能。
