Glard Yann, Gay André, Valenti David, Berwald Christian, Guinard Didier, Legré Régis
Department of Plastic and Reconstructive Surgery, Hôpital de la Conception, Marseille, France.
J Hand Surg Am. 2006 Nov;31(9):1461-7. doi: 10.1016/j.jhsa.2006.08.005.
Osteoarthritis at the base of the thumb is a common problem, especially in women. Among the many surgical procedures aimed at restoring the function of the trapeziometacarpal joint, total trapeziectomy has been shown to provide good long-term results in most patients. But in some patients continued pain may lead the surgeon to consider a revision procedure. We report the use of costochondral autograft as an interposition material in revision of trapeziectomy in trapeziometacarpal osteoarthritis and to study its usefulness.
The study design was retrospective. All of the patients had a costochondral autograft as a revision procedure after a failed trapeziectomy with ligament reconstruction. Patients were clinically assessed before and after surgery. The follow-up period was 24 months. Results were assessed as follows: good, complete relief of pain; fair, persistent mild pain and stiffness; poor, no relief of pain or any improvement with revision surgery.
Four patients were included; there were 2 good results, 2 fair results, and no poor result. Pain relief was obtained in all patients. Thumb opposition showed a slight improvement in 1 patient and no change in the other 3 patients. Pinch strength showed no change. One case of iatrogenic injury of the sensory branch of the radial nerve was noted.
Costochondral autograft as a revision procedure after failed trapeziectomy is a reliable procedure. These preliminary outcomes showed that the result did not compare favorably with soft-tissue interposition. Nevertheless, in case of an iterative procedure, the lack of available soft-tissue material to interpose may lead the surgeon to consider a costochondral autograft. This procedure should be considered a salvage procedure.
拇指基部骨关节炎是一个常见问题，尤其在女性中。在众多旨在恢复大多角骨-第一掌骨关节功能的外科手术中，大多角骨切除术已被证明能在大多数患者中提供良好的长期效果。但在一些患者中，持续疼痛可能会促使外科医生考虑进行翻修手术。我们报告了使用自体肋软骨作为大多角骨切除术翻修术中的植入材料，并研究其有效性。
本研究设计为回顾性研究。所有患者在大多角骨切除术联合韧带重建失败后，接受了自体肋软骨植入作为翻修手术。对患者在手术前后进行临床评估。随访期为24个月。结果评估如下：优，疼痛完全缓解；良，持续轻度疼痛和僵硬；差，疼痛未缓解或翻修手术无任何改善。
纳入4例患者；2例结果为优，2例结果为良，无差的结果。所有患者均获得了疼痛缓解。1例患者拇指对掌功能略有改善，其他3例患者无变化。捏力无变化。记录到1例桡神经感觉支医源性损伤。
在大多角骨切除术失败后，自体肋软骨植入作为翻修手术是一种可靠的手术方法。这些初步结果表明，其效果与软组织植入相比并不理想。然而，在进行反复手术的情况下，缺乏可用的软组织材料进行植入可能会促使外科医生考虑使用自体肋软骨植入。该手术应被视为一种挽救性手术。
