Larsen Solveig K A, Østergaard Ann Mai, Hansen Torben B
Department of Radiology, Regional Hospital Holstebro, Lægårdvej 12, 7500 Holstebro, Denmark.
University Clinic for Hand, Hip, and Knee Surgery, Regional Hospital Holstebro, Aarhus University, Aarhus, Denmark.
Hand (N Y). 2015 Dec;10(4):593-7. doi: 10.1007/s11552-015-9765-8. Epub 2015 Apr 28.
The role of subluxation in staging of the severity of osteoarthritic changes remains unclear. The aim of this study was to evaluate the influence of subluxation of symptomatic osteoarthritic trapeziometacarpal (TMC) joint regarding severity of symptoms, disability, and results of operative treatment in TMC osteoarthritis with total joint arthroplasty.
We included 172 hands in 137 patients (32 males and 105 females), mean age 59 years (44-74 years), with a combination of radiological signs of TMC osteoarthritis and clinical symptoms in the study. All patients were operated in general anaesthesia where a ball and socket joint implant was used. Disability of the Arm, Shoulder and Hand (DASH) score, visual analog scale, grip strength, and abduction deficiency were recorded and subluxation was measured on computed tomography.
The mean subluxation in males was 5.2 mm (SD 1.2) and in females 5.3 mm (SD 1.3) (p = 0.95). We found a weak positive correlation between grip strength and subluxation both at the preoperative examination and at 3 and 12 months after the operation, but no other correlations with subluxation were found.
This study indicates that radial subluxation may not be an important factor in symptoms and function in patients with symptomatic TMC osteoarthritis without severe scaphotrapezio (ST) joint degeneration. In addition, preoperative subluxation seems not to be important for the result after total joint arthroplasty.
半脱位在骨关节炎性改变严重程度分期中的作用仍不明确。本研究的目的是评估有症状的骨关节炎性大多角骨-第一掌骨关节（TMC）半脱位对症状严重程度、功能障碍以及TMC骨关节炎行全关节置换术手术治疗结果的影响。
本研究纳入了137例患者（32例男性和105例女性）的172只手，平均年龄59岁（44 - 74岁），这些患者同时具有TMC骨关节炎的影像学表现和临床症状。所有患者均在全身麻醉下接受手术，术中使用球窝关节植入物。记录上肢、肩部和手部功能障碍（DASH）评分、视觉模拟量表、握力和外展受限情况，并通过计算机断层扫描测量半脱位情况。
男性的平均半脱位为5.2毫米（标准差1.2），女性为5.3毫米（标准差1.3）（p = 0.95）。我们发现在术前检查以及术后3个月和12个月时，握力与半脱位之间均存在弱正相关，但未发现与半脱位的其他相关性。
本研究表明，对于没有严重舟大多角（ST）关节退变的有症状的TMC骨关节炎患者，桡侧半脱位可能不是症状和功能的重要影响因素。此外，术前半脱位似乎对全关节置换术后的结果并不重要。
