Chung Kevin C, Ram Ashwin N, Shauver Melissa J
Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, and the University of Michigan Medical School.
Plast Reconstr Surg. 2009 May;123(5):1521-1532. doi: 10.1097/PRS.0b013e3181a2059b.
Arthritis of the proximal interphalangeal joint is a debilitating condition commonly treated with arthroplasty. The pyrolytic carbon (pyrocarbon) implant has been developed for proximal interphalangeal joint arthroplasty in these patients. This prospective outcomes study evaluated the outcomes and complications of the pyrocarbon implant for the proximal interphalangeal joint.
Consecutive candidates for proximal interphalangeal joint arthroplasty with pyrocarbon implants were evaluated prospectively. Functional measurements and the Michigan Hand Outcomes Questionnaire were administered preoperatively and at 3, 6, and 12 months postoperatively. Preoperative means and 12-month postoperative means for all functional measures were compared using paired t tests and nonparametric Wilcoxon signed rank sum test, and effect size was reported for the Michigan Hand Outcomes Questionnaire.
Fourteen patients treated with 21 implants were enrolled in the study. At the 12-month follow-up period, mean active arc of motion was 38 degrees, decreasing slightly from the preoperative value. Mean grip strength improved from 11.3 kg to 15.1 kg, although the difference was not statistically significant. Mean key pinch values improved significantly from 6.6 kg preoperatively to 9.2 kg at the 12-month follow-up (p = 0.03). Jebsen-Taylor test scores showed improvement, although not significantly. Changes in all Michigan Hand Outcomes Questionnaire domains showed a large effect size. Three patients experienced squeaking of the implant and three patients experienced dislocation of the pyrocarbon joint.
The pyrocarbon implant for proximal interphalangeal joint arthroplasty shows encouraging results, primarily in patient satisfaction and pain relief, but is associated with complications related to implant dislocations, which required prolonged treatment with external fixators.
近端指间关节关节炎是一种使人衰弱的疾病，通常采用关节成形术进行治疗。热解碳植入物已被开发用于这些患者的近端指间关节成形术。这项前瞻性结局研究评估了热解碳植入物用于近端指间关节的结局和并发症。
对连续采用热解碳植入物进行近端指间关节成形术的患者进行前瞻性评估。术前以及术后3个月、6个月和12个月进行功能测量并使用密歇根手部结局问卷。使用配对t检验和非参数威尔科克森符号秩和检验比较所有功能测量的术前均值和术后12个月均值，并报告密歇根手部结局问卷的效应量。
14例接受21枚植入物治疗的患者纳入研究。在12个月的随访期，平均主动活动弧为38度，较术前值略有下降。平均握力从11.3千克提高到15.1千克，尽管差异无统计学意义。平均捏力值从术前的6.6千克显著提高到12个月随访时的9.2千克（p = 0.03）。杰布森 - 泰勒测试评分有所改善，尽管不显著。密歇根手部结局问卷所有领域的变化均显示出较大的效应量。3例患者出现植入物吱吱声，3例患者出现热解碳关节脱位。
用于近端指间关节成形术的热解碳植入物显示出令人鼓舞的结果，主要体现在患者满意度和疼痛缓解方面，但与植入物脱位相关的并发症有关，这需要使用外固定器进行长期治疗。
