Koff Matthew F, Zhao Kristin D, Mierisch Cay M, Chen Meng-Yi, An Kai-Nan, Cooney William P
Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905, USA.
J Hand Surg Am. 2007 May-Jun;32(5):688-96. doi: 10.1016/j.jhsa.2007.02.009.
Osteoarthritis (OA) of the thumb carpometacarpal (CMC) joint causes pain and limits thumb motion. Different surgical procedures exist to treat thumb CMC OA; however, kinematic analyses of thumb reconstructions are limited. The purpose of this study was to evaluate kinematic changes of the thumb CMC joint as the result of different thumb reconstruction procedures.
Fifteen cadaveric forearms were prepared and instrumented with an electromagnetic tracking device to measure the motion of the thumb metacarpal with respect to the trapezium (thumb trapeziometacarpal joint). Kinematics of the intact thumb and the thumb after trapeziectomy under passive motion were recorded. Specimens then had joint reconstruction consisting of either a ligament reconstruction with tendon interposition (LRTI), Weilby arthroplasty, or Thompson arthroplasty. The kinematic data collection analysis was repeated. The radius of joint motion and 3-dimensional (3D) work area were calculated for each surgery and were used for statistical analysis.
The type of surgical treatment significantly affected the joint radius of motion and the 3D work area. The Thompson and LRTI techniques produced a larger joint radius of motion than the other techniques (Weilby technique and total trapezial resection) and was similar to that of the intact joint. The Weilby and LRTI techniques produced a 3D work area similar to those of the intact joint and trapeziectomy and was also larger than that of the Thompson reconstruction.
Kinematic analysis of the thumb CMC joint is effective in differentiating surgical treatments used for end-stage of OA. Only the LRTI reconstruction produced a joint radius of motion and a 3D work area similar to the those of an intact thumb. Additional research is needed to define the optimal surgical techniques to treat the end-stage OA thumb CMC joint.
拇指腕掌（CMC）关节骨关节炎（OA）会引起疼痛并限制拇指活动。存在多种治疗拇指CMC OA的手术方法；然而，拇指重建的运动学分析有限。本研究的目的是评估不同拇指重建手术对拇指CMC关节运动学变化的影响。
准备15具尸体前臂，并安装电磁跟踪装置以测量拇指掌骨相对于大多角骨（拇指大多角骨掌关节）的运动。记录被动运动下完整拇指和大多角骨切除术后拇指的运动学数据。然后对标本进行关节重建，包括肌腱嵌入韧带重建（LRTI）、韦尔比关节成形术或汤普森关节成形术。重复进行运动学数据收集分析。计算每种手术的关节运动半径和三维（3D）工作区域，并用于统计分析。
手术治疗类型显著影响关节运动半径和3D工作区域。汤普森和LRTI技术产生的关节运动半径比其他技术（韦尔比技术和完全大多角骨切除术）更大，且与完整关节相似。韦尔比和LRTI技术产生的3D工作区域与完整关节和大多角骨切除术相似，也大于汤普森重建术。
拇指CMC关节的运动学分析可有效区分用于OA终末期的手术治疗方法。只有LRTI重建产生的关节运动半径和3D工作区域与完整拇指相似。需要进一步研究来确定治疗终末期OA拇指CMC关节的最佳手术技术。
