Raven E E J, Kerkhoffs G M M J, Rutten S, Marsman A J W, Marti R K, Albers G H R
Department of Orthopaedics and Traumatology, Gelre Ziekenhuizen Apeldoorn, P.O. Box 9014, 7300 DS Apeldoorn, The Netherlands.
Int Orthop. 2007 Aug;31(4):547-54. doi: 10.1007/s00264-006-0217-5. Epub 2006 Sep 22.
Trapeziometacarpal osteoarthritis is a common entity, often bilateral and predominantly affecting postmenopausal women. In the case of failure of conservative treatment, surgery is a good option. The aim of this study was to compare three surgical procedures. 63 patients (74 thumbs) with osteoarthritis of the trapezio-metacarpal joint were surgically treated; 54 patients were seen for follow-up, 7 had died and 2 were lost to follow-up. The patients were stratified according to treatment; resection arthroplasty (the joint surface's of the metacarpal and the trapezium are resected) (18 thumbs), trapeziectomy with tendon interposition (17 thumbs) or trapezio-metacarpal arthrodesis (28 thumbs). Baseline characteristics were comparable in the three groups for mean age at operation, Eaton classification, left right distribution and dominant hands operated. The average follow-up was 13 years for the resection group, 8 years for the trapeziectomy group and 9 years for the arthrodesis group. No statistically significant difference between the three groups was found for the visual analogue pain and satisfaction scale, pain frequency nor DASH score. Patients in the trapeziectomy group had significantly less pain compared to the arthrodesis group (p=0.025). Statistically, radial abduction was significantly better after trapeziectomy compared to resection arthroplasty (p<0.01) or arthrodesis (p=0.01). There was no difference among the three groups in grip and tip pinch strength nor in pain on palpation. None of the patients in the trapeziectomy group needed a re-operation, one patient in the resection arthroplasty group had a re-operation, and 22 patients in the arthrodesis group had one or more re-operations for hardware removal or because of a complication. This study shows that the resection arthroplasty has equally good long term results compared to trapeziectomy combined with tendon interposition or arthrodesis. Resection arthroplasty is performed through a single incision and is technically simple. In our clinic resection arthroplasty is therefore the preferred technique for the treatment of osteoarthritis of the trapeziometacarpal joint.
大多角骨-掌骨关节骨关节炎是一种常见病症，通常为双侧发病，主要影响绝经后女性。若保守治疗失败，手术是一种不错的选择。本研究的目的是比较三种手术方法。63例（74个拇指）大多角骨-掌骨关节骨关节炎患者接受了手术治疗；54例患者接受了随访，7例死亡，2例失访。患者根据治疗方法分层；切除关节成形术（切除掌骨和大多角骨的关节面）（18个拇指）、带肌腱植入的大多角骨切除术（17个拇指）或大多角骨-掌骨关节融合术（28个拇指）。三组患者在手术平均年龄、伊顿分类、左右分布和手术的优势手方面的基线特征具有可比性。切除组的平均随访时间为13年，大多角骨切除组为8年，关节融合组为9年。在视觉模拟疼痛和满意度量表、疼痛频率或DASH评分方面，三组之间未发现统计学上的显著差异。与关节融合组相比，大多角骨切除组患者的疼痛明显减轻（p = 0.025）。从统计学上看，与切除关节成形术（p < 0.01）或关节融合术（p = 0.01）相比，大多角骨切除术后桡侧外展明显更好。三组在握力和指尖捏力以及触诊疼痛方面没有差异。大多角骨切除组没有患者需要再次手术，切除关节成形术组有1例患者再次手术，关节融合组有22例患者因取出内固定物或出现并发症而进行了一次或多次再次手术。本研究表明，与带肌腱植入的大多角骨切除术或关节融合术相比，切除关节成形术具有同样良好的长期效果。切除关节成形术通过单一切口进行，技术上简单。因此，在我们的诊所，切除关节成形术是治疗大多角骨-掌骨关节骨关节炎的首选技术。
