Wall Lindley B, Stern Peter J
Department of Orthopaedic Surgery, Washington University, St. Louis, MO 63110, USA.
J Hand Surg Am. 2013 Mar;38(3):537-43. doi: 10.1016/j.jhsa.2012.11.026. Epub 2013 Jan 20.
To determine the effectiveness of pyrolytic carbon arthroplasty for the management of primary osteoarthritis of the metacarpophalangeal joint.
A retrospective review of 11 pyrolytic carbon arthroplasties for osteoarthritis of the metacarpophalangeal joint, performed by a single surgeon, was conducted. All patients returned for clinical assessment at a minimum of 2 years after surgery. Evaluation included range of motion, pain and functional scores, and patient satisfaction. Validated outcome measures included the Michigan Hand Questionnaire and Quick Disabilities of the Arm, Shoulder, and Hand. Radiographs were assessed for implant failure, loosening, migration, and subsidence.
The average follow-up was 4 years (minimum 2 y). The arc of motion significantly improved from 62° before surgery to 76° after surgery. Grip strength decreased slightly compared to the contralateral side (average, 3 kg). The average pain score was 1 on a 10-point visual analog scale. All but 1 patient were fully satisfied at final follow-up. All patients who were working before surgery returned to work after surgery. The Michigan Hand Questionnaire average score was 80, and the Quick Disabilities of the Arm, Shoulder, and Hand average score was 22. Two patients experienced persistent, asymptomatic squeaking and clicking, and 1 patient reported extensor tendon subluxation. One joint had conversion to arthrodesis for continued, unexplained pain. All surviving implants had a surrounding lucency on radiographs. The average subsidence was 3 mm; there was no implant migration, fracture, or dislocation.
Pyrolytic carbon arthroplasties of the metacarpophalangeal joint resulted in satisfactory outcomes at average 4-year follow-up, with improved joint motion, good pain relief and satisfaction, and few complications. Radiographic outcomes revealed a consistent, asymptomatic surrounding lucency with no evidence of implant failure or migration.
确定热解碳关节成形术治疗掌指关节原发性骨关节炎的有效性。
对由一名外科医生实施的11例掌指关节骨关节炎热解碳关节成形术进行回顾性研究。所有患者在术后至少2年返回进行临床评估。评估内容包括活动范围、疼痛和功能评分以及患者满意度。经过验证的结果测量指标包括密歇根手部问卷和手臂、肩部和手部快速残疾评估量表。对X线片进行评估，以确定植入物是否失败、松动、移位和下沉。
平均随访时间为4年（最短2年）。活动弧度从术前的62°显著改善至术后的76°。握力与对侧相比略有下降（平均下降3kg）。在10分制视觉模拟量表上，平均疼痛评分为1分。除1例患者外，所有患者在最终随访时均完全满意。所有术前工作的患者术后均恢复工作。密歇根手部问卷平均评分为80分，手臂、肩部和手部快速残疾评估量表平均评分为22分。2例患者出现持续的无症状摩擦音和弹响，1例患者报告伸肌腱半脱位。1个关节因持续存在且无法解释的疼痛而改行关节融合术。所有留存的植入物在X线片上均有周围透亮区。平均下沉为3mm；没有植入物移位、骨折或脱位。
掌指关节热解碳关节成形术在平均4年的随访中取得了令人满意的结果，关节活动改善、疼痛缓解良好且患者满意度高，并发症较少。X线片结果显示，植入物周围持续出现无症状透亮区，无植入物失败或移位的迹象。
