Stahlenbrecher A, Hoch J
Klinikum Neustadt, Klinik für Hand-, Brust- und Plastische Chirurgie, Neustadt/Holstein.
Handchir Mikrochir Plast Chir. 2009 Jun;41(3):156-65. doi: 10.1055/s-0029-1220921. Epub 2009 Jun 16.
Proximal interphalangeal joint arthroplasty with a silicone implant has proven to be successful in cases of degenerative, post-traumatic or rheumatic arthritis. The recent changing of the implant's design by introducing a 30-degree preflexion has replaced the common Swanson implant in some centres. Nevertheless, directly comparing follow-up studies between the two implant forms are still lacking as well as the use of a standard evaluation score for proximal interphalangeal joint arthroplasties. Between 1990 and 2007 a series of 67 proximal interphalangeal joint arthroplasties with a silicone device has been carried out in 54 patients. Among these a retrospective clinical and radiological investigation could be performed on 43 patients with 53 joints at 6-144, in the mean 34 months, after operation. 39 cases of degenerative, 12 cases of post-traumatic, 1 case of rheumatic arthritis and 1 post-traumatic arthrodesis were treated with 20 Swanson implants and 33 NeuFlex implants. In 41 joints a mediolateral approach taking care of the extensor tendon's integrity was used, in 12 joints the extensor tendon was dissected longitudinally using a dorsal approach. At the time of investigation 5 implants had already been removed due to infection, implant fracture and painful extensive osteophytes. Comparing the remaining prostheses, 18 Swanson implants and 30 NeuFlex implants, the latter showed a better average total range of motion, improving from 42.5 degrees preoperatively to 56 degrees postoperatively, in contrast to the Swanson implants with a deterioration from 50.8 degrees preoperatively to 47.2 degrees postoperatively. However, they were inferior to the classic Swanson implant as the joint's circumference was more enlarged by 1.8 mm in the mean and a greater finger length shortening of average 2.5 mm as well as a higher rate of stress pain and instability (15%) were evident. While the NeuFlex implants led to a better subjective satisfaction, the Swanson implants gained better objective results using a new evaluation score (11% very good, 50% good, 28% satisfactory, 11% bad) than the NeuFlex implants (50% good, 40% satisfactory, 10% bad). Remarkably the NeuFlex devices showed an extremely high rate of early implant fractures after 8-31 months, in the mean 18 months, postoperatively, which was not seen with any of the Swanson implants--in spite of an average duration of 59.4 months.
硅胶植入物近端指间关节置换术已被证明在退行性、创伤后或风湿性关节炎病例中是成功的。最近通过引入30度预弯曲改变了植入物的设计，在一些中心已取代了常见的斯旺森（Swanson）植入物。然而，目前仍缺乏两种植入物形式的随访研究之间的直接比较，也缺乏用于近端指间关节置换术的标准评估评分。1990年至2007年期间，对54例患者进行了一系列67例硅胶装置近端指间关节置换术。其中，对43例患者的53个关节进行了回顾性临床和放射学调查，术后6至144个月，平均34个月。39例退行性关节炎、12例创伤后关节炎、1例风湿性关节炎和1例创伤后关节融合术患者分别使用了20个斯旺森植入物和33个NeuFlex植入物进行治疗。41个关节采用内外侧入路并注意伸肌腱的完整性，12个关节采用背侧入路纵向切开伸肌腱。在调查时，由于感染、植入物骨折和疼痛性广泛骨赘，已有5个植入物被取出。比较剩余的假体，即18个斯旺森植入物和30个NeuFlex植入物，后者的平均总活动范围更好，从术前的42.5度提高到术后的56度，相比之下，斯旺森植入物则从术前的50.8度恶化到术后的47.2度。然而，它们不如经典的斯旺森植入物，因为关节周长平均增大了1.8毫米，手指长度平均缩短了2.5毫米，且应力性疼痛和不稳定的发生率更高（15%）。虽然NeuFlex植入物带来了更好的主观满意度，但使用新的评估评分时，斯旺森植入物的客观结果更好（11%非常好，50%好，28%满意，11%差），优于NeuFlex植入物（50%好，40%满意，10%差）。值得注意的是，NeuFlex装置在术后8至31个月，平均18个月时，早期植入物骨折率极高，而所有斯旺森植入物均未出现这种情况，尽管其平均使用时长为59.4个月。
