Afendras G, Abramo A, Mrkonjic A, Geijer M, Kopylov P, Tägil M
Hand and Upper Extremity Unit, Department of Orthopaedics, Clinical Sciences, Lund University, Lund, Sweden.
J Hand Surg Eur Vol. 2010 Oct;35(8):627-31. doi: 10.1177/1753193410373311. Epub 2010 May 28.
Fracture dislocations of the PIP joint are challenging to treat. In hemi-hamate arthroplasty, the palmar lip joint surface is reconstructed using an osteochondral graft from the hamate and the immediate stability permits early movement. In the long term, collapse of non-vascularized osteochondral grafts might lead to degenerative arthritis. We examined the radiographic result after a minimum of 4 years with special reference to the development of osteoarthritis and its relation to clinical symptoms in eight patients, mean age 49 (25-66) years. After a mean of 60 (48-69) months, the arc of motion was 67° (45°-95°) at the PIP joint and grip strength was 91% of the uninjured side. The visual analogue score for pain (0-100) was 10 (0-70) mm. Severe arthritis (grade IV) was found in two and mild arthritis (grade II) in another two patients, but only one of these four cases had troublesome pain. The hemi-hamate technique is an attractive alternative to other treatment options, but some cases develop osteoarthritis in the medium term.
近端指间关节骨折脱位的治疗具有挑战性。在半钩骨置换术中，使用来自钩骨的骨软骨移植物重建掌侧唇关节面，即时稳定性允许早期活动。从长远来看，非血管化骨软骨移植物的塌陷可能导致退行性关节炎。我们对8例平均年龄49岁（25 - 66岁）的患者进行了至少4年的影像学检查，特别关注骨关节炎的发展及其与临床症状的关系。平均60个月（48 - 69个月）后，近端指间关节的活动弧度为67°（45° - 95°），握力为健侧的91%。疼痛的视觉模拟评分（0 - 100）为10（0 - 70）mm。两名患者发现严重关节炎（IV级），另外两名患者发现轻度关节炎（II级），但这四例中只有一例有明显疼痛。半钩骨技术是其他治疗选择的一个有吸引力的替代方法，但一些病例在中期会发展为骨关节炎。
