Gwynne-Jones D P, Penny I D, Sewell S A, Hughes T H
Department of Orthopaedic Surgery, Dunedin Hospital, Dunedin, New Zealand.
J Orthop Surg (Hong Kong). 2006 Apr;14(1):58-63. doi: 10.1177/230949900601400113.
To review the subjective and functional results of basal thumb metacarpal osteotomy for the treatment of trapeziometacarpal osteoarthritis.
Between July 1993 and November 1998, 35 thumb osteotomies without internal fixation were performed on 33 patients in the Christchurch Hospital, New Zealand. Records of 28 thumbs (13 right and 15 left) of 26 patients (17 women and 9 men) were available for review. Patients were reviewed using strength testing and the Michigan Hand Outcomes Questionnaire.
The mean age of the 26 patients was 54 years (range, 30-69 years). Of the 28 thumbs, 22 (21 patients) had good or excellent results, 2 fair, one poor. The remaining 3 thumbs (3 patients) required further revision and were classified as failures. The mean follow-up period of the 25 thumbs (24 patients) not requiring revision was 34 months (range, 12-73 months). Good thumb motion was present in all hands with no trapeziometacarpal instability seen. Compared with the normative data, the strengths of key pinch, pulp pinch, and tripod pinch of our patients were significantly lower (22-32% lower), but not the grip strength. Michigan Hand Outcomes Questionnaire scores increased 28 (range, 1-56) points after surgery, with significant improvement especially in pain (+44 points), activities of daily living (one-handed tasks, +41 points), and satisfaction (+35 points).
Basal thumb metacarpal osteotomy is a straightforward, conservative procedure that should be considered for grades II and III trapeziometacarpal osteoarthritis.
回顾拇指掌骨基底截骨术治疗第一腕掌关节骨关节炎的主观和功能结果。
1993年7月至1998年11月期间，新西兰克赖斯特彻奇医院对33例患者实施了35例无内固定的拇指截骨术。现可回顾26例患者（17例女性和9例男性）的28例拇指（13例右手和15例左手）的记录。采用力量测试和密歇根手功能结果问卷对患者进行评估。
26例患者的平均年龄为54岁（范围30 - 69岁）。28例拇指中，22例（21例患者）结果为良好或优秀，2例为中等，1例为差。其余3例拇指（3例患者）需要进一步翻修，被归类为失败病例。25例无需翻修的拇指（24例患者）的平均随访期为34个月（范围12 - 73个月）。所有手部拇指活动良好，未见第一腕掌关节不稳定。与标准数据相比，患者的捏力、指尖捏力和三指捏力显著降低（低22% - 32%），但握力未降低。密歇根手功能结果问卷评分术后提高了28分（范围1 - 56分），尤其在疼痛（提高44分）、日常生活活动（单手任务，提高41分）和满意度（提高35分）方面有显著改善。
拇指掌骨基底截骨术是一种简单、保守的手术方法，对于II级和III级第一腕掌关节骨关节炎应予以考虑。
