Wong Tak-Chuen, Ip Fu-Keung
Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China.
Hand Surg. 2009;14(2-3):83-7. doi: 10.1142/S0218810409004281.
We performed a retrospective review of 22 thumbs in 22 Chinese patients attending for the basal joint arthritis of the thumb over the last 14 years. There were 16 women and six men with a mean age of 50 years old. All were treated surgically by partial trapeziectomy and volar oblique ligament reconstruction with flexor carpi radialis tendon and interpositional arthroplasty with a free palmaris longus tendon ball after failure of conservative treatment. The mean follow-up time was 48 months. Radiographs did not show any differences in the arthroplasty space index, arthroplasty space, trapezial space ratio and scaphoid-thumb metacarpal distance at the pre-operative evaluation and at the final follow-up evaluation. There was significant difference in the pain score, grip strength, Kapandji score and functional status before and after surgery at final follow-up period. One patient had complex regional pain syndrome which was resolved after receiving a course of anti-inflammatory drugs and physiotherapy. The authors suggest that the modified technique of partial trapeziectomy with tendon interpositional arthroplasty is a safe and effective method in treating basal joint arthritis of the thumb with good short term functional and radiological outcomes and minimal complication.
我们对过去14年中因拇指基底关节关节炎前来就诊的22例中国患者的22根拇指进行了回顾性研究。其中有16名女性和6名男性,平均年龄为50岁。所有患者在保守治疗失败后均接受了手术治疗,包括部分大多角骨切除术、用桡侧腕屈肌腱重建掌侧斜韧带以及用游离掌长肌腱球进行间置关节成形术。平均随访时间为48个月。术前评估和最终随访评估时的X线片显示,关节成形术间隙指数、关节成形术间隙、大多角骨间隙比和舟状骨-拇指掌骨距离均无差异。最终随访期手术前后的疼痛评分、握力、卡潘迪评分和功能状态存在显著差异。1例患者出现复杂性区域疼痛综合征,在接受一个疗程的抗炎药物治疗和物理治疗后得到缓解。作者认为,改良的部分大多角骨切除术联合肌腱间置关节成形术是治疗拇指基底关节关节炎的一种安全有效的方法,具有良好的短期功能和影像学效果,并发症最少。