Heyworth Benton E, Jobin Charles M, Monica James T, Crow Scott A, Lee Jonathan H, Rosenwasser Melvin P
Department of Orthopaedic Surgery, Columbia College of Physicians and Surgeons, New York, NY, USA.
J Hand Surg Am. 2009 Jul-Aug;34(6):1021-8. doi: 10.1016/j.jhsa.2009.03.016.
To investigate the long-term functional and clinical outcomes of a tendon transfer during basal joint interposition arthroplasty for osteoarthritis of the basal joint of the thumb, in which the origin of the abductor pollicis brevis (APB) and opponens pollicis is transferred to the flexor carpi radialis tendon, in order to increase the abduction moment arm of the thumb and provide dynamic stabilization of the base of the first metacarpal.
We observed 22 patients, who received basal joint interposition arthroplasty with APB and opponens pollicis tendon transfer, over an average of 9 years (range, 3-20 years). Subjective outcome measures included patient satisfaction scores, visual analog scale scores for pain, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Clinical evaluations included thumb range of motion, grip strength, and pinch strength.
At an average follow-up of 9 years, 95% of patients (21 out of 22) subjectively scored the procedure as good or excellent and reported improvement in activities of daily living. Mean visual analog scale pain score was 4.4 at rest and 7.8 with activity (out of 100), and mean DASH score was 13.3 (out of 100). Average grip strength of the operated hand was equal to that of the contralateral hand, and lateral and tip pinch strengths were 79% and 93%, respectively, of the contralateral hand. No intraoperative or early postoperative complications were reported, although 1 patient whose procedure was performed as treatment for failed silastic arthroplasty reported metacarpal instability at 9-year follow-up (DASH score of 22).
Basal joint arthroplasty with APB and opponens pollicis tendon transfers provides excellent long-term results for carpometacarpal thumb osteoarthritis. The procedure is safe, with a low complication rate. Its success has long-term durability as measured by patient satisfaction, functional outcome measures, range of motion, and strength.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
研究在拇指掌指关节骨关节炎的掌指关节间置关节成形术中进行肌腱转移的长期功能和临床疗效。在该手术中，将拇短展肌（APB）和拇对掌肌的起点转移至桡侧腕屈肌腱，以增加拇指的外展力臂并为第一掌骨基部提供动态稳定。
我们观察了22例接受掌指关节间置关节成形术并进行APB和拇对掌肌腱转移的患者，平均随访9年（范围为3至20年）。主观结果指标包括患者满意度评分、疼痛视觉模拟量表评分以及手臂、肩部和手部功能障碍（DASH）评分。临床评估包括拇指活动范围、握力和捏力。
平均随访9年时，95%的患者（22例中的21例）主观上将该手术评为良好或优秀，并报告日常生活活动有所改善。静息时平均视觉模拟量表疼痛评分为4.4，活动时为7.8（满分100），平均DASH评分为13.3（满分100）。患侧手的平均握力与对侧手相等，侧捏力和指尖捏力分别为对侧手的79%和93%。未报告术中或术后早期并发症，尽管1例因硅胶关节成形术失败而接受该手术治疗的患者在9年随访时报告掌骨不稳定（DASH评分为22）。
采用APB和拇对掌肌腱转移的掌指关节成形术为第一掌腕关节拇指骨关节炎提供了优异的长期疗效。该手术安全，并发症发生率低。通过患者满意度、功能结果指标、活动范围和力量来衡量，其成功具有长期持续性。
研究类型/证据水平：治疗性IV级。
