Orthopaedics and Hand Surgery, The Catholic University School of Medicine, Rome, Italy.
Orthop Traumatol Surg Res. 2011 Nov;97(7):726-33. doi: 10.1016/j.otsr.2011.05.008. Epub 2011 Oct 5.
Trapeziectomy and ligament reconstructions are favoured by surgeons concerned that telescoping of the thumb may reduce its function. However, theoretically ligamentoplasties are at risk to develop tendinosis or tendon rupture or trigger a complex regional pain syndrome type 1.
Authors tested the looping of a slip from the abductor pollicis longus (APL) tendon around the first intermetacarpal ligament. They intended to use a surgical treatment which does not require bone tunnelling or looping around a tendon. Their results support the hypothesis that this new technique is a valid addition among treatments for carpometacarpal arthritis.
Forty-two patients were followed up to one year. Each patient had subjective assessment for: pain; function (DASH score); overall satisfaction. An objective assessment was used for: first web span angle; abduction and opposition; key pinch; grip strength. Tests were performed prior to surgery, then at three, six and 12 months. X-ray films were taken to monitor thumb height.
A substantial improvement in all these parameters was measured in all patients. X-ray films showed the mantainance of a physiological heigth after one year. We recorded one complication of keloid and two of temporary dysesthesia but no case of tendinosis, delayed rupture, or CRPS 1. Mean operative time was 27 minutes.
Simplification and search for a technique which avoids the looping around a tendon is why the authors undertook this study. Advantages are the small number of required steps, short time of surgery and comfortable postoperative rehab regimen for the patient. The technique provides a distal anchoring point (without bone tunnelling). It is quite respectful of anatomy and physiology, in minimizing the re-routing of functioning tendons. We propose it as an effective procedure both to expand the armamentarium for treating the thumb carpometacarpal joint osteoarthritis and/or to simplify the ligamentoplasties already in use.
对于担心拇指伸缩会降低其功能的外科医生来说，腕掌切开术和韧带重建术是首选。然而，理论上，韧带成形术有发生腱鞘炎或肌腱断裂的风险，或引发 1 型复杂性区域疼痛综合征。
作者测试了从拇长展肌（APL）肌腱绕过第一掌骨间韧带的滑线。他们打算使用一种不需要骨隧道或肌腱绕线的手术治疗方法。他们的结果支持这样一种假设，即这种新技术是治疗腕掌关节炎的有效方法之一。
42 例患者随访 1 年。每位患者均进行主观评估：疼痛；功能（DASH 评分）；总体满意度。客观评估包括：第一掌间横弓角；外展和对掌；侧捏；握力。术前、术后 3、6 和 12 个月进行测试。拍摄 X 线片以监测拇指高度。
所有患者的所有这些参数均有显著改善。X 线片显示术后 1 年拇指高度维持生理高度。我们记录了 1 例瘢痕疙瘩并发症和 2 例暂时性感觉异常，但无腱鞘炎、迟发性断裂或 1 型复杂性区域疼痛综合征。平均手术时间为 27 分钟。
简化并寻找一种避免肌腱绕线的技术是作者进行这项研究的原因。该技术的优点是所需步骤少、手术时间短、患者术后康复方案舒适。该技术提供了一个远端锚固点（无需骨隧道）。它非常尊重解剖学和生理学，最大限度地减少了功能肌腱的重新布线。我们建议将其作为一种有效的治疗拇指腕掌关节骨关节炎的方法，或简化已在使用的韧带成形术。
