Brunton Lance M, Wittstadt Raymond A
The Curtis National Hand Center, Baltimore, MD 21218, USA.
Tech Hand Up Extrem Surg. 2011 Jun;15(2):115-8. doi: 10.1097/BTH.0b013e3181f8c94a.
Few surgical techniques that address advanced thumb carpometacarpal osteoarthrosis specifically allow early mobilization postoperatively. After trapeziectomy, we carry out a ligament reconstruction using an absorbable interference screw to secure a flexor carpi radialis tendon autograft within the first metacarpal base. Theoretically, superior tendon graft fixation strength allows early mobilization within 2 weeks postoperatively. We have retrospectively compared our clinical results using this technique with another group of patients who underwent traditional ligament reconstruction and tendon interposition as described by Burton and Pellegrini. There were no differences in the verbal pain score, satisfaction rating, or DASH scores between groups. There was a statistically significant decrease in trapezial space ratio both at rest and with stress for the experimental group. Although the clinical significance of this finding is largely unknown, it did not correlate with clinical outcome in our patients. Although no conclusions could be drawn regarding early mobilization after thumb carpometacarpal arthroplasty, further studies are planned to investigate this intriguing aspect of postoperative care. In this article, we present the details of the surgical technique and postoperative rehabilitation.
很少有专门针对晚期拇指腕掌关节骨关节炎的手术技术能允许术后早期活动。在大多角骨切除术后,我们使用可吸收加压螺钉进行韧带重建,将桡侧腕屈肌腱自体移植物固定于第一掌骨基底内。从理论上讲,较高的肌腱移植物固定强度允许在术后2周内早期活动。我们回顾性地比较了使用该技术的临床结果与另一组接受如Burton和Pellegrini所描述的传统韧带重建和肌腱间置术的患者的结果。两组之间在言语疼痛评分、满意度评级或DASH评分方面没有差异。实验组在静息和应力状态下大多角骨间隙比均有统计学意义的下降。尽管这一发现的临床意义很大程度上尚不清楚,但它与我们患者的临床结果无关。虽然关于拇指腕掌关节置换术后早期活动无法得出结论,但计划进一步研究以探讨术后护理的这一有趣方面。在本文中,我们介绍了手术技术和术后康复的细节。