Orthopaedic and Traumatology Department, La Cavale Blanche Teaching Hospital Center, boulevard Tanguy-Prigent, 29200 Brest, France.
Orthop Traumatol Surg Res. 2009 Sep;95(5):352-8. doi: 10.1016/j.otsr.2009.03.015. Epub 2009 Jul 29.
Numerous procedures are in use to treat trapeziometacarpal osteoarthritis. Most of these techniques impair hand function. In a series of trapeziectomies stabilized by ligament reconstruction with tendon suspension, we investigated whether eventual parameters influenced hand function and dexterity.
Some parameters influence hand function recovery following trapeziectomy combined to ligamento-tendinous stabilization.
This is a continuous, retrospective, single surgeon series; 60 cases of thumb trapeziometacarpal osteoarthritis were treated with trapeziectomy and ligament reconstruction (40 palmaris longus, and 20 half flexor carpi radialis) with no additional metacarpophalangeal (MCP) joint surgery. Besides assessing classical clinical outcome criteria (pain, mobility, force), we analyzed hand function: this was obtained with a questionnaire about different everyday movements. Five types of grip were included in this analysis: spherical, pinch grasp, key pinch, power grip, and precision pinch.
Fifty-one trapeziectomies (85%) were evaluated at an average follow-up of 7.5 years (5-11.5). Ninety-four percent of patients had good results for pain. The average Kapandji score for mobility was 9.6 (6-10) with a mean web angle at 36.5 degrees. Hyperextension of the MCP joint occurred in 36 cases and measured an average of 26 degrees (5 degrees-50 degrees). Compared to the contralateral side average strength was 97% with the Jamar dynamometer and 88% for the key pinch. The rate of satisfaction was 96%. Collapse of trapezial height was constant, and at last follow-up, the trapezial index was 50% of its preoperative initial value. The results relative to hand function assessment were good in 58% of patients. The spherical grip was the most difficult to restore. The analysis of the 42% of patients with average or poor hand function showed five prognostic factors for a poor outcome: young age at surgery, persisting postoperative pain, postoperative hyperextension of the MCP joint, reduced postoperative web angle and trapezial space collapse.
Level IV. Therapeutic study.
有许多方法可用于治疗腕掌关节炎。其中大多数技术会损害手部功能。在一系列通过韧带重建和肌腱悬吊稳定的腕掌关节切开术中，我们研究了最终参数是否会影响手部功能和灵巧度。
一些参数会影响腕掌关节切开术联合韧带固定术后手部功能的恢复。
这是一项连续的、回顾性的、单外科医生的研究系列，共 60 例拇指腕掌关节炎患者接受了腕掌关节切开术和韧带重建（40 例掌长肌，20 例半屈肌）治疗，未行掌指关节（MCP）关节手术。除了评估经典的临床结果标准（疼痛、活动度、力量）外，我们还分析了手部功能：通过问卷调查不同日常活动来评估。该分析包括五种抓握类型：球形抓握、捏握、指腹捏握、力握和精确捏握。
51 例（85%）患者在平均 7.5 年（5-11.5 年）的随访中得到评估。94%的患者疼痛缓解效果良好。活动度的平均 Kapandji 评分为 9.6（6-10），平均掌腕角为 36.5 度。MCP 关节过伸发生在 36 例患者中，平均测量值为 26 度（5-50 度）。与对侧相比，握力计平均握力为 97%，指腹捏握力为 88%。满意度为 96%。腕骨高度的塌陷是恒定的，最后一次随访时，腕骨指数为术前初始值的 50%。手部功能评估结果良好的患者占 58%。球形抓握最难恢复。对 42%平均或手部功能较差的患者进行分析，发现 5 个预后不良的因素：手术时年龄较小、术后持续疼痛、术后 MCP 关节过伸、术后掌腕角和腕骨空间减小。
IV 级。治疗研究。
