Ghavami Ashkan, Oishi Scott N
Department of Plastic and Reconstructive Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9132, USA.
Plast Reconstr Surg. 2006 May;117(6):116e-128e. doi: 10.1097/01.prs.0000214652.31293.23.
After studying this article, the participant should be able to: 1. Understand the pathomechanical and biochemical basis for thumb trapeziometacarpal joint degeneration. 2. Diagnose and grade trapeziometacarpal joint disease based on presentation, physical examination (including provocative testing), and radiographic evidence. 3. Understand the principles of ligament reconstruction and tendon arthroplasty procedures. 4. Describe the surgical technique for ligament reconstruction tendon interposition arthroplasty and its variants.
Osteoarthritis of the trapeziometacarpal joint is the second most common site of degenerative joint disease in the hand, and mostly affects postmenopausal women. Degenerative arthritis of the thumb trapeziometacarpal joint is associated with a lack of bony constraints and laxity of the supporting ligaments, particularly the anterior oblique ("beak") ligament, which is consistently implicated in disease progression. Resultant increases in joint stress loads leads eventually to metacarpal and trapezial articular destruction, thumb instability, and pain.
In this article, the authors review the diagnosis and treatment modalities available to the surgeon in the treatment of patients with trapeziometacarpal osteoarthritis. The technique of ligament reconstruction tendon interposition arthroplasty is discussed in detail.
Ligament reconstruction tendon interposition arthroplasty procedures center on three common principles: (1) excision of the diseased trapezium; (2) reconstruction of the beak ligament; and (3) interposition of a tissue substance to maintain metacarpal position.
Both conservative and surgical management can be effective in the treatment of trapeziometacarpal arthritis, when properly selected. The success of ligament reconstruction tendon interposition arthroplasty in treating trapeziometacarpal arthritis has withstood the test of time.
在学习本文后，参与者应能够：1. 理解拇指大多角掌骨关节退变的病理力学和生化基础。2. 根据临床表现、体格检查（包括激发试验）和影像学证据诊断并分级大多角掌骨关节疾病。3. 理解韧带重建和肌腱成形术的原则。4. 描述韧带重建肌腱植入关节成形术及其变体的手术技术。
大多角掌骨关节的骨关节炎是手部退行性关节疾病的第二常见部位，主要影响绝经后女性。拇指大多角掌骨关节的退行性关节炎与缺乏骨约束和支持韧带松弛有关，尤其是前斜（“喙”）韧带，该韧带一直被认为与疾病进展有关。由此导致的关节应力负荷增加最终会导致掌骨和大多角骨的关节破坏、拇指不稳定和疼痛。
在本文中，作者回顾了外科医生在治疗大多角掌骨骨关节炎患者时可用的诊断和治疗方法。详细讨论了韧带重建肌腱植入关节成形术的技术。
韧带重建肌腱植入关节成形术围绕三个共同原则进行：（1）切除病变的大多角骨；（2）重建喙韧带；（3）植入一种组织物质以维持掌骨位置。
当选择适当时，保守治疗和手术治疗在大多角掌骨关节炎的治疗中都可能有效。韧带重建肌腱植入关节成形术治疗大多角掌骨关节炎的成功经受住了时间的考验。
