Clinique d'orthopédie B, hôpital Roger-Salengro, CHRU de Lille, boulevard Emile-Laine, 59045 Lille cedex, France.
Orthop Traumatol Surg Res. 2009 Feb;95(1):63-9. doi: 10.1016/j.otsr.2008.06.001. Epub 2009 Feb 18.
Osteoarthritis of the thumb basal joint is the most common location for hand degenerative joint disease. First, carpometacarpal (CMC) joint arthroplasty is one treatment option. The purpose of this article is to present the outcome of the GUEPAR II prosthesis, a total trapeziometacarpal cemented implant of the retaining ball-and-socket design type. Numerous other advantageous features of this implant, second generation of an earlier version are explored.
Clinical and radiological results confirm the GUEPAR II trapeziometacarpal arthroplasty as a reliable and efficient evolution of earlier prosthetic designs.
Eighty-four GUEPAR II prostheses were implanted to treat advanced and severely incapacitating first CMC osteoarthritis. The average follow-up time in this collaborative series (from 2 centers) was 50 months.
There were no intraoperative complications and no dislocations at the final follow-up evaluation, 92% of patients were satisfied or very satisfied with their results with objective improvement of their Kapandji score. Strength was closely comparable to the nonaffected side. Radiographic studies at the final follow-up evaluations did not show (except in one socket revision instance) signs of implant loosening. On occasion, non-progressive radiolucent lines were observed. More than 80% of the patients remained pain free.
In our series, GUEPAR II total joint arthroplasty of the thumb CMC joint has proven to be efficacious, improving motion, strength, and achieving a high degree of pain relief. Successful outcome appears in our experience contingent upon strict compliance with numerous surgical technique details. Current research focuses on improving bipolar fixation by developing press-fit cementless implants.
拇指基底关节骨关节炎是手部退行性关节疾病最常见的部位。首先，腕掌（CMC）关节置换术是一种治疗选择。本文的目的是介绍 GUEPAR II 假体的结果，这是一种保留球窝设计类型的全 trapeziometacarpal 骨水泥植入物。还探讨了这种植入物的许多其他有利特征，这是早期版本的第二代。
临床和影像学结果证实 GUEPAR II 腕掌关节置换术是早期假体设计的可靠和有效的演变。
共植入 84 个 GUEPAR II 假体，以治疗晚期和严重致残的第一 CMC 骨关节炎。在这个协作系列（来自 2 个中心）中，平均随访时间为 50 个月。
术中无并发症，末次随访时无脱位，92%的患者对结果满意或非常满意，Kapandji 评分客观改善。力量与非受影响侧密切可比。末次随访的影像学研究未显示（除了一个 socket 翻修实例外）植入物松动的迹象。偶尔会观察到非进行性透亮线。超过 80%的患者仍然没有疼痛。
在我们的系列中，拇指 CMC 关节的 GUEPAR II 全关节置换术已被证明是有效的，可改善运动、力量，并获得高度的疼痛缓解。成功的结果出现在我们的经验中，取决于严格遵守许多手术技术细节。目前的研究重点是通过开发压配合非骨水泥植入物来改善双极固定。
