Luria Shai, Waitayawinyu Thanapong, Nemechek Nicholas, Huber Philippe, Tencer Allan F, Trumble Thomas E
Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine, Seattle, WA 98195-6500, USA.
J Hand Surg Am. 2007 May-Jun;32(5):697-706. doi: 10.1016/j.jhsa.2007.02.025.
Thumb carpometacarpal joint arthritis has been commonly treated with some combination of resection of the trapezium and interposition of a spacer using either a biologic or artificial material plus tenodesis to reconstruct the volar oblique ligament. The purpose of this study was to evaluate the biomechanic stability of the classic ligament reconstruction with tendon interposition (LRTI) or without tendon interposition compared with a newly developed 1-piece silicone trapezium implant.
Twelve cadaver arm specimens had the following procedures: resection of the trapezium, tendon interposition, ligament reconstruction, LRTI, and the silicone implant. Biomechanic testing of joint stability was performed with a physiologic loading protocol before and after each procedure.
The implant significantly corrected the axial displacement after trapeziectomy and resulted in less radial displacement than LRTI. It significantly reduced angulation of the thumb metacarpal base but resulted in more rotation of the thumb during simulated pinch. There was no significant difference in stability measures between trapeziectomy and LRTI or ligament reconstruction without tendon interposition.
We found several biomechanic advantages to the implant compared with LRTI. Advantages include reduction in axial and radial displacement and maintenance of the trapezial space. We attribute these advantages to the effect of the implant as a spacer. The significant rotation with the implant, however, raises questions concerning implant design and fixation. We found no biomechanic advantage to LRTI or ligament reconstruction without tendon interposition over trapeziectomy alone.
拇指腕掌关节关节炎的常见治疗方法是采用某种组合方式，即切除大多角骨，并使用生物材料或人工材料置入间隔物，再加上腱固定术来重建掌侧斜韧带。本研究的目的是评估经典的带肌腱置入的韧带重建术（LRTI）或不带肌腱置入的韧带重建术与新开发的一体式硅胶大多角骨植入物相比的生物力学稳定性。
对12个尸体手臂标本进行以下操作：切除大多角骨、肌腱置入、韧带重建、LRTI和硅胶植入。在每个操作前后，采用生理负荷方案对关节稳定性进行生物力学测试。
该植入物在大多角骨切除术后显著纠正了轴向移位，且导致的桡侧移位比LRTI少。它显著减少了拇指掌骨基底的成角，但在模拟捏持过程中导致拇指更多的旋转。在大多角骨切除术与LRTI或不带肌腱置入的韧带重建术之间，稳定性测量结果没有显著差异。
我们发现与LRTI相比，该植入物具有几个生物力学优势。优势包括减少轴向和桡侧移位以及维持大多角骨间隙。我们将这些优势归因于植入物作为间隔物的作用。然而，植入物导致的显著旋转引发了有关植入物设计和固定的问题。我们发现LRTI或不带肌腱置入的韧带重建术相对于单纯的大多角骨切除术没有生物力学优势。
