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[大多角骨切除伴悬吊及间置关节成形术后的临床及影像学结果]

[Clinical and radiological outcome after trapezium resection with suspension and interposition arthroplasty].

作者信息

Glehr M, Jeserschek R, Gruber G, Parsché G, Zacherl M, Maurer-Ertl W, Windhager R

机构信息

Universitätsklinik für Orthopädie und orthopädische Chirurgie, Medizinische Universität Graz, Osterreich.

出版信息

Z Orthop Unfall. 2010 May;148(3):326-31. doi: 10.1055/s-0029-1240735. Epub 2010 Feb 17.

Abstract

INTRODUCTION

Trapezium resection with suspension and interposition arthroplasty of the thumb-carpometacarpal joint is a common method for treatment of severe osteoarthritis of the 1st carpometacarpal joint.

METHODS

We performed a single center retrospective data analysis after trapezium resection with suspension and interposition arthroplasty of the thumb-carpometacarpal joint with emphasis on quality of life and radiological parameters 3.4 years (1.2-8.7 years) after operation in 60 patients. Pre- and postoperative pain was analysed with VAS, function was measured using the DASH score, pinch grip power with a pinchmeter.

RESULTS

Subjective outcome was rated excellent in 42 cases (64.6%), good in 17 (26.2%), fair in 3 (4.6%) and 3 times (4.6%) poor. 56 patients (93.3%) would like to be operated again; 4 patients (6.7%) would deny an operation retrospectively. In the VAS pain was reduced by about 75% compared to the preoperative value. The pinch grip was increased by 46.6% compared to the preoperative value. The rate of major complications was 1.5% and of minor complications 9.2 %.

CONCLUSION

Trapezium resection with suspension and interposition arthroplasty can increase the quality of life and reduce pain in patients with severe osteoarthritis of the 1st carpometacarpal joint. The rate of complications is low. Outcome assessment is possible by subjective parameters. Objective values like the range of movement or the decrease of the distance between metacarpal I and scaphoid do not correlate with outcome.

摘要

引言

大多角骨切除术联合拇指腕掌关节悬吊及置入成形术是治疗第一腕掌关节重度骨关节炎的常用方法。

方法

我们对60例患者进行了大多角骨切除术联合拇指腕掌关节悬吊及置入成形术后的单中心回顾性数据分析,重点关注术后3.4年(1.2 - 8.7年)的生活质量和影像学参数。采用视觉模拟评分法(VAS)分析术前和术后疼痛情况,使用DASH评分评估功能,用握力计测量捏力。

结果

主观结果评定为优42例(64.6%),良17例(26.2%),可3例(4.6%),差3例(4.6%)。56例患者(93.3%)愿意再次接受手术;4例患者(6.7%)回顾性拒绝手术。与术前相比,VAS疼痛评分降低约75%。捏力较术前增加46.6%。主要并发症发生率为1.5%,次要并发症发生率为9.2%。

结论

大多角骨切除术联合悬吊及置入成形术可提高第一腕掌关节重度骨关节炎患者的生活质量并减轻疼痛。并发症发生率低。可通过主观参数进行结果评估。像活动范围或第一掌骨与舟骨间距离减小等客观值与结果无关。

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