Bouacida S, Lazerges C, Coulet B, Chammas M
Service de chirurgie orthopédique 2 : chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
Chir Main. 2014 Oct;33(5):350-5. doi: 10.1016/j.main.2014.07.004. Epub 2014 Sep 16.
Proximal interphalangeal joint arthroplasty through a volar approach preserves the extensor apparatus, which allows for early active rehabilitation. Here, we report on the results of 28 silicone implants in patients suffering from rheumatoid arthritis (12 joints) or osteoarthritis (16 joints) with a mean follow-up of 39 months. Pain was reduced significantly after arthroplasty. Range of motion increased significantly by 29° with a mean postoperative value of 58°; the mean extension deficit was reduced from 14° to 5°. There were 18 cases of preoperative ulnar drift with a mean value of 13°, compared with 13 cases postoperatively with a mean value of 7°. Three cases (10%) of implant fracture were noted on the radiology reports. The mean DASH score at follow-up was 35/100. Immediate active mobilization led to significant shortening in recovery time. The improvement in mobility and extension seems to be higher than that obtained with other approaches. Clinodactyly remains problematic no matter the type of arthroplasty.
经掌侧入路的近端指间关节置换术可保留伸肌装置，这有利于早期进行主动康复训练。在此，我们报告了28例接受硅酮植入物治疗的类风湿性关节炎患者（12个关节）和骨关节炎患者（16个关节）的结果，平均随访时间为39个月。关节置换术后疼痛明显减轻。活动范围显著增加了29°，术后平均值为58°；平均伸展缺陷从14°降至5°。术前有18例尺侧偏斜，平均值为13°，术后为13例，平均值为7°。放射学报告显示有3例（10%）植入物骨折。随访时的平均DASH评分为35/100。立即进行主动活动可显著缩短恢复时间。与其他入路相比，活动度和伸展度的改善似乎更高。无论采用何种关节置换术，手指弯曲畸形仍然是个问题。
