Fatzer Lukas, Soleman E, Sanchez T
Handchirurgie, Orthopädische Klinik, Kantonsspital Olten, Schweiz.
Plastische-, Rekonstruktive-, Ästhetische- und Handchirurgie, Universitätsspital Basel, Schweiz.
Handchir Mikrochir Plast Chir. 2015 Feb;47(1):1-6. doi: 10.1055/s-0034-1398607. Epub 2015 Feb 4.
A distraction arthroplasty of the trapeziometacarpal joint was introduced by Bufalini and Perugia for the treatment of the early stages of carpometacarpal osteoarthritis. Our retrospective study presents the results of this technique. Thereby, a tendon graft anchored to the distal second metacarpal is fixed at the base of the first metacarpal, keeping it in distraction.
10 distraction arthroplasties were performed in 9 patients with carpometacarpal osteoarthritis stage I and II of the thumb after unsuccessful conservative therapy. In 2 cases, which were excluded from our study, trapeziectomy had to be performed because of persisting pain. Patient satisfaction, pain measurement, range of motion, and tip, key and grip strength were evaluated at a follow-up of 46.5 (29-63) months in the remaining 7 patients (8 operations overall). Strengh measurement was taken in an absolute value and compared to the opposite side. Thumb range of motion was measured with the combined flexion-opposition of the thumb with the Kapandij index and also the angle of abduction of the metacarpal I to metacarpal II. Assessment included a DASH score evaluation and an X-ray control.
All of the 7 evaluated patients were satisfied with the operation results. Compared to the opposite side, patients achieved 80.1% (5.9 kg±1.1 kg) of key pinch strength, 86.3% (4.8 kg±0.9 kg) of oppositional tip pinch strength, and 86.1% (23.1 kg±4.8 kg) of grip strength. In combined flexion and opposition a Kapandij index of 8.5 (94.4%) compared to 9 on the opposite side was achieved. Thumb radial abduction was 48.2°±2.8°, compared to 51.0°±2.9° on the contralateral hand. At follow-up, the mean DASH score was 17.8 (±10.0). Radiological control showed no progression of carpometacarpal osteoarthritis of the thumb.
The collected data after distraction arthroplasty according to Bufalini and Perugia confirm the efficacy of the technique in the early stage of carpometacarpal osteoarthritis of the thumb. Even though a failure rate of 20% occurred, in our opinion the operation is justified in the early stages of carpometacarpal osteoarthritis of the thumb as the patients benefit from a pain-free interval, leaving the option for future trapeziectomy.
布法利尼和佩鲁贾引入了一种大多角骨-第一掌骨关节撑开成形术来治疗腕掌骨关节炎的早期阶段。我们的回顾性研究展示了该技术的结果。具体而言，将锚定在第二掌骨远端的肌腱移植物固定在第一掌骨基部，使其保持撑开状态。
对9例经保守治疗无效的Ⅰ期和Ⅱ期拇指腕掌骨关节炎患者实施了10例撑开成形术。有2例因持续疼痛不得不进行大多角骨切除术，被排除在我们的研究之外。对其余7例患者（共8次手术）在46.5（29 - 63）个月的随访中评估了患者满意度、疼痛测量、活动范围以及捏力、钥匙捏力和握力。力量测量采用绝对值，并与对侧进行比较。拇指活动范围通过拇指的联合屈曲-对掌动作的卡潘迪伊指数以及第一掌骨与第二掌骨的外展角度来测量。评估包括DASH评分评估和X线检查。
所有7例接受评估的患者对手术结果满意。与对侧相比，患者的钥匙捏力达到了80.1%（5.9千克±1.1千克），对掌捏力达到了86.3%（4.8千克±0.9千克），握力达到了86.1%（23.1千克±4.8千克）。在联合屈曲和对掌动作中，卡潘迪伊指数为8.5（94.4%），而对侧为9。拇指桡侧外展角度为48.2°±2.8°，对侧为51.0°±2.9°。随访时，平均DASH评分为17.8（±10.0）。影像学检查显示拇指腕掌骨关节炎无进展。
根据布法利尼和佩鲁贾方法进行撑开成形术后收集的数据证实了该技术在拇指腕掌骨关节炎早期的有效性。尽管出现了20%的失败率，但我们认为在拇指腕掌骨关节炎早期进行该手术是合理的，因为患者可从中获得无痛期，为未来的大多角骨切除术留下选择余地。
