44 个月平均随访时近端指间关节热解碳关节成形术的结果。
Outcomes of pyrolytic carbon arthroplasty for the proximal interphalangeal joint at 44 months' mean follow-up.
机构信息
Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, and the Department of Neurosurgery, The University of Michigan Health System.
出版信息
Plast Reconstr Surg. 2012 May;129(5):1139-1150. doi: 10.1097/PRS.0b013e31824a2e38.
BACKGROUND
Short-term results after proximal interphalangeal joint arthroplasty with pyrolytic carbon (pyrocarbon) implant have shown that this implant has high complication rates, but patient satisfaction is high. The authors evaluated the effectiveness of the implant for use in proximal interphalangeal joint at a minimum of 2 years of follow-up.
METHODS
Thirteen consecutive candidates who underwent 21 proximal interphalangeal joint arthroplasty procedures with pyrocarbon implant were evaluated prospectively. Functional measurements and the Michigan Hand Outcomes Questionnaire were administered preoperatively and at 12 months and intermediate term (>2 years) postoperatively. Preoperative and intermediate-term mean data for all functional measures and questionnaire scores were compared.
RESULTS
Thirteen patients were treated, with a mean follow-up of 44 months. Grip strength, key pinch strength, and active arc of motion demonstrated no statistical difference between preoperative and intermediate-term assessment. All domains of the Michigan Hand Outcomes Questionnaire showed improved large effect size at intermediate-term follow-up, especially pain and satisfaction. There were 10 complications in nine joints (complication rate, 42.9 percent). Patients without complications had better functional outcomes; however, there were no statistical differences in questionnaire scores between patients with and without complications, except for pain (p = 0.04).
CONCLUSIONS
Proximal interphalangeal joint arthroplasty with pyrocarbon implant seems to be an effective way of reducing pain without sacrificing active arc of motion. Despite a high complication rate, patients were generally satisfied, especially with pain relief, and complications did not affect patients' satisfaction even when hand function was affected. Further decision-making analysis to compare arthroplasty and fusion for each finger may help surgeons to select the appropriate operative procedures.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
背景
近节指间关节采用热解碳（pyrocarbon）植入物关节成形术的短期结果表明，该植入物的并发症发生率较高，但患者满意度较高。作者评估了该植入物在近节指间关节的使用效果，随访时间至少为 2 年。
方法
连续 13 名候选者接受了 21 例近端指间关节热解碳植入物关节成形术，前瞻性评估。术前、术后 12 个月和中期（>2 年）进行功能测量和密歇根手功能问卷评估。比较所有功能测量和问卷评分的术前和中期平均数据。
结果
13 例患者接受治疗，平均随访 44 个月。握力、关键捏力和主动活动度在术前和中期评估之间无统计学差异。密歇根手功能问卷的所有领域在中期随访时均显示出较大的改善，特别是疼痛和满意度。9 个关节中有 10 个并发症（并发症发生率为 42.9%）。无并发症的患者功能结果更好；然而，在有无并发症的患者之间，除了疼痛（p=0.04）外，问卷评分无统计学差异。
结论
近节指间关节热解碳植入物关节成形术似乎是一种减轻疼痛而不牺牲主动活动度的有效方法。尽管并发症发生率较高，但患者总体满意度较高，尤其是疼痛缓解，即使手部功能受到影响，并发症也不会影响患者的满意度。进一步的决策分析比较每个手指的关节成形术和融合术可能有助于外科医生选择合适的手术程序。
临床问题/证据水平：治疗，IV。
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