Dickson David R, Nuttall David, Watts Adam C, Talwalkar Sumedh C, Hayton Mike, Trail Ian A
Upper Limb Unit, Wrightington Hospital, Wigan, Lancashire, United Kingdom.
Upper Limb Unit, Wrightington Hospital, Wigan, Lancashire, United Kingdom.
J Hand Surg Am. 2015 Nov;40(11):2142-2148.e4. doi: 10.1016/j.jhsa.2015.08.009. Epub 2015 Oct 1.
To report the outcomes, complications, and survivorship of pyrocarbon proximal interphalangeal joint arthroplasty at a minimum of 5-year follow-up.
A review of 97 implants in 72 consecutive patients from our joint arthroplasty database was undertaken. Patient demographics, complications, further surgery, and implant revision were recorded. Objective outcome was assessed by grip strength, range of motion, and radiological assessment of alignment, loosening, and subsidence. Subjective outcome was assessed by Patient Evaluation Measure; Quick Disabilities of the Arm, Shoulder, and Hand score; and visual analog scores (0, best; 10, worst) for appearance, satisfaction, and pain.
Diagnosis was osteoarthritis in 60 joints, rheumatoid arthritis in 12 joints, psoriatic arthritis in 11 joints, and trauma in 14 joints. The average follow-up was 118 months (range, 60-164 months). The mean arc of motion was 35° (range, 0° to 90°). There was no difference in grip strength between operated and nonoperated side. Of the 97 implants, 36 required additional surgery, of which 14 were revised and 22 required reconstruction around a retained implant. The average Patient Evaluation Measure and Quick Disabilities of the Arm, Shoulder and Hand scores were 33 (range, 10-69) and 35 (range, 0-93), respectively. Mean visual analog scores for pain, satisfaction, and appearance were 2 (range, 0-8), 7 (0-10), and 8 (0-10), respectively. All implants had a lucent line with nearly all classified as either Herren grade 2 or 3. Progressive loosening was seen in 48% of implants. Implant survival as assessed by Kaplan-Meier was 85% at both 5 and 10 years.
Good pain relief and maintenance of preoperative arc of motion was achieved with no major deterioration over time. Most implant revisions were performed within 24 months of the index procedure. Currently progressive loosening was not translated into revision surgery. Implant revision rate was higher than with other prostheses.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
报告焦碳酸近端指间关节置换术至少5年随访的结果、并发症及假体生存率。
对我们关节置换数据库中72例连续患者的97枚植入物进行回顾性研究。记录患者人口统计学资料、并发症、进一步手术情况及假体翻修情况。通过握力、活动范围以及对线、松动和下沉的影像学评估来评价客观结果。通过患者评估量表、手臂、肩部和手部快速残疾评分以及外观、满意度和疼痛的视觉模拟评分（0分为最佳；10分为最差）来评价主观结果。
60个关节诊断为骨关节炎，12个关节为类风湿关节炎，11个关节为银屑病关节炎，14个关节为创伤性关节炎。平均随访时间为118个月（范围60 - 164个月）。平均活动弧度为35°（范围0°至90°）。手术侧与非手术侧握力无差异。97枚植入物中，36枚需要再次手术，其中14枚进行了翻修，22枚需要围绕保留的植入物进行重建。患者评估量表和手臂、肩部和手部快速残疾评分的平均值分别为33（范围10 - 69）和35（范围0 - 93）。疼痛、满意度和外观的平均视觉模拟评分分别为2（范围0 - 8）、7（0 - 10）和8（0 - 10）。所有植入物均有透亮线，几乎所有均分类为赫伦2级或3级。48%的植入物出现进行性松动。根据Kaplan - Meier法评估，5年和10年时假体生存率均为85%。
实现了良好的疼痛缓解和术前活动弧度的维持，且未随时间出现明显恶化。大多数假体翻修在初次手术的24个月内进行。目前进行性松动尚未转化为翻修手术。假体翻修率高于其他假体。
研究类型/证据水平：治疗性IV级。
