Goubau J F, Ackerman P, Kerckhove D, Van Hoonacker P, Berghs B
Department of Orthopaedics and Traumatology, Upper Limb Unit, AZ Sint-Jan AV Brugge - Oostende, Campus Brugge, Belgium.
J Hand Surg Eur Vol. 2012 Feb;37(2):138-44. doi: 10.1177/1753193411416056. Epub 2011 Aug 22.
Trapeziometacarpal instability with trapezial dysplasia is a disabling condition long before the radiological changes of osteoarthritis appear. In dysplastic joints surgical soft tissue correction fails to prevent the instability, requiring a correction of the bony anatomy. We combined two techniques described in the past, an abduction osteotomy of the first metacarpal and an opening wedge osteotomy of the trapezium, to which we added a ligament reconstruction. The combination of both osteotomy techniques restores the anatomy and centres the forces acting across the joint. We have done this procedure 21 times since 2003 in 18 patients. Seventeen thumbs were reviewed prospectively with a mean follow-up of 39 (range 16-65) months. Mean QuickDASH improved by 33.9 points, the key pinch improved by 1.8 kg and the grip strength improved by 8.7 kg. The visual analogue scale for pain improved from 7.9 preoperatively to 2 postoperatively. This technique preserves the trapeziometacarpal joint, allowing other techniques to be used if painful arthritis should develop in the middle to long term.
伴有大多角骨发育异常的大多角骨-第一掌骨间不稳定在骨关节炎的放射学改变出现之前很久就是一种致残性病症。在发育异常的关节中，手术软组织矫正无法预防不稳定，需要进行骨解剖结构的矫正。我们将过去描述的两种技术——第一掌骨外展截骨术和大多角骨开放楔形截骨术——相结合，并增加了韧带重建。两种截骨技术的结合恢复了解剖结构，并使作用于关节的力居中。自2003年以来，我们在18例患者中进行了21次该手术。对17例拇指进行了前瞻性评估，平均随访39（范围16 - 65）个月。平均QuickDASH评分提高了33.9分，关键捏力提高了1.8千克，握力提高了8.7千克。疼痛视觉模拟量表评分从术前的7.9改善至术后的2。该技术保留了大多角骨-第一掌骨间关节，若中长期出现疼痛性关节炎，还可采用其他技术。
