Sandvall Brinkley K, Cameron Todd E, Netscher David T, Epstein Michael J, Staines Kimberly Goldie, Petersen Nancy J
Department of Orthopedic Surgery and Division of Plastic Surgery, Baylor College of Medicine, Houston, TX, USA.
J Hand Surg Am. 2010 Dec;35(12):1968-75. doi: 10.1016/j.jhsa.2010.08.034. Epub 2010 Nov 12.
Thumb basilar osteoarthritis is common. Several surgical options exist. Studies have evaluated outcomes in separate cohorts but have not compared methods. Our study compared the functional outcome of ligament reconstruction and tendon interposition (LRTI) suspension arthroplasty and hematoma distraction arthroplasty (HDA) by patient questionnaires, clinical measurements, and radiographic measurements to see whether there is validity in exclusively using either LRTI or HDA.
In this retrospective study, patients received LRTI (12 thumbs in 11 patients) or HDA (9 thumbs in 9 patients) according to the attending surgeon's preference, one exclusively performing LRTI and the other HDA. Patient perception was evaluated with a QuickDASH questionnaire and 10-point pain visual analog scale (VAS). Potential QuickDASH scores range from 0 to 100, with lower scores indicating better function. Clinical evaluation examined grip strength, tip pinch, and lateral pinch in kilograms-force, and range of motion. Measurements were compared with those from the contralateral hand and published normal values. Stressed and unstressed radiographs assessed metacarpal proximal and lateral migration and first web space. Chart review documented surgical times.
The LRTI and HDA scored similarly on QuickDASH. Most reported excellent pain relief. Average grip, tip pinch, and lateral pinch were also similar in both groups. None achieved significance. Comparisons with contralateral hand and published normal results showed that LRTI and HDA were comparable. All except 2 could oppose to little finger base. With stress, additional proximal migration was similar. Web space was preserved with both procedures. LRTI took 54 minutes longer.
The LRTI and HDA were comparable on all levels of objective and subjective measurements. Both groups satisfied the principal goals to provide a stable, mobile, pain-free thumb.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
拇指基底节骨关节炎很常见。有多种手术选择。已有研究评估了不同队列的手术结果，但未对不同方法进行比较。我们的研究通过患者问卷、临床测量和影像学测量，比较了韧带重建与肌腱嵌入（LRTI）悬吊关节成形术和血肿撑开关节成形术（HDA）的功能结果，以确定单纯使用LRTI或HDA是否有效。
在这项回顾性研究中，根据主刀医生的偏好，患者接受LRTI（11例患者的12根拇指）或HDA（9例患者的9根拇指），其中一位医生只进行LRTI，另一位只进行HDA。通过QuickDASH问卷和10分疼痛视觉模拟量表（VAS）评估患者的感受。QuickDASH潜在分数范围为0至100，分数越低表明功能越好。临床评估包括以千克力为单位检查握力、指尖捏力和侧捏力，以及活动范围。将测量结果与对侧手的结果和已公布的正常值进行比较。在应力和非应力状态下的X线片评估掌骨近端和侧向移位以及第一掌骨间隙。查阅病历记录手术时间。
LRTI和HDA在QuickDASH上得分相似。大多数患者报告疼痛缓解良好。两组的平均握力、指尖捏力和侧捏力也相似。均未达到显著差异。与对侧手及已公布的正常结果比较显示，LRTI和HDA具有可比性。除2例患者外，所有患者的拇指均可与小指基部对掌。在应力状态下，额外的近端移位相似。两种手术方法均保留了掌骨间隙。LRTI手术时间长54分钟。
LRTI和HDA在客观和主观测量的各个层面上具有可比性。两组均达到了提供稳定、可活动、无痛拇指的主要目标。
研究类型/证据水平：治疗性III级。
