Roulet S, Bacle G, Marteau E, Laulan J
Unité de chirurgie de la main, services de chirurgie orthopédique et traumatologique 1 et 2, hôpital Trousseau, CHU de Tours, avenue de la République, 37044 Tours cedex, France.
Unité de chirurgie de la main, services de chirurgie orthopédique et traumatologique 1 et 2, hôpital Trousseau, CHU de Tours, avenue de la République, 37044 Tours cedex, France.
Hand Surg Rehabil. 2017 Apr;36(2):109-112. doi: 10.1016/j.hansur.2016.12.004. Epub 2017 Feb 7.
Carpal boss is a symptomatic bony protrusion on the dorsal surface of the wrist at the base of the 2nd and/or 3rd metacarpal. The goal of this study was to assess the reliability and safety of simply resecting the exostosis. From 1994 to 2014, 29 cases of carpal boss were treated by simple resection. Twenty-five of these patients were subsequently assessed by telephone questionnaire at a mean of 8 years' follow-up (range 1.1 to 20 years). There were no cases of recurrence; however, 1 patient reported carpometacarpal instability requiring fusion, 5 years after surgery. Eight of the 24 patients without fusion (33%) reported moderate episodic pain (visual analog scale [VAS] pain: mean, 2.3/10, range 1 to 4). Range of motion improved in 8 cases (33%), was unchanged in 11 (46%) and decreased in 5 (21%). Twenty patients (83%) had no functional impairment; 4 reported impairment during unusual hand movements. Fifteen patients considered themselves cured (60%), 9 considered their status improved (36%) and one - the patient who required fusion - considered his status unchanged. Patients were very satisfied with the procedure in 15 cases (60%) and satisfied in 10 (40%). In all cases, features of dysplasia were present and associated with secondary osteoarthritis limited to the area of impingement. The single failure was most likely due to excessive bone resection. Simple exostosis resection is sufficient to effectively treat carpal boss. Fusion should be reserved for the rare cases of secondary metacarpal instability.
腕部腱鞘囊肿是在第2和/或第3掌骨基部腕背侧出现的有症状的骨性突起。本研究的目的是评估单纯切除外生骨疣的可靠性和安全性。1994年至2014年，29例腕部腱鞘囊肿患者接受了单纯切除术。其中25例患者随后通过电话问卷调查进行评估，平均随访8年（范围1.1至20年）。没有复发病例；然而，1例患者在术后5年报告掌指关节不稳定需要融合。24例未进行融合的患者中有8例（33%）报告有中度发作性疼痛（视觉模拟评分法[VAS]疼痛：平均2.3/10，范围1至4）。8例（33%）患者的活动范围改善，11例（46%）不变，5例（21%）减小。20例患者（83%）无功能障碍；4例报告在异常手部运动时有功能障碍。15例患者（60%）认为自己已治愈，9例（36%）认为病情有所改善，1例（即需要融合的患者）认为病情未变。15例患者（60%）对手术非常满意，10例（40%）满意。在所有病例中，均存在发育异常特征，并伴有局限于撞击区域的继发性骨关节炎。唯一的失败病例很可能是由于过度切除骨质。单纯切除外生骨疣足以有效治疗腕部腱鞘囊肿。融合术应仅用于罕见的继发性掌骨不稳定病例。
