Herold Christian, Rennekampff Hans-Oliver, Groddeck Robert, Allert Sixtus
Hameln, Leverkusen, and Oldenburg, Germany.
From the Department of Plastic, Aesthetic Surgery, and Hand Surgery, Sana Klinikum Hameln Pyrmont; Plastic and Aesthetic Surgery, Department of Orthopaedic, Trauma, Hand, and Reconstructive Surgery, Klinikum Leverkusen; and the Klinik für Kinder- und Jugendpsychiatrie/Psychosomatik und Psychotherapie, Klinikum Oldenburg.
Plast Reconstr Surg. 2017 Aug;140(2):327-335. doi: 10.1097/PRS.0000000000003510.
Most operations for carpometacarpal joint osteoarthritis of the thumb irreversibly alter or destroy the anatomy. There is a high demand for minimally invasive alternatives. The authors report the results of autologous fat transfer for treatment of thumb carpometacarpal joint osteoarthritis.
In a prospective study, 50 patients with thumb carpometacarpal joint osteoarthritis were observed for 1 year after autologous fat transfer. Manual liposuction and centrifugation were performed. Pain rating according to visual analogue pain scale; objective force of pinch grip and fist closure; and Disabilities of the Arm, Shoulder, and Hand questionnaire scores before and after treatment were analyzed.
The average pain in stage 2 patients preoperatively was 7.7 ± 1.3; it was 1.8 ± 1.9 after 6 months and 2.4 ± 3.1 after 12 months. Patients with stage 2 osteoarthritis demonstrated a superior benefit from this treatment compared with patients with either stage 3 or stage 4 thumb carpometacarpal joint osteoarthritis. There were similar improvements for the parameters strength and Disabilities of the Arm, Shoulder, and Hand questionnaire score. No serious adverse events were observed.
Autologous fat transplantation is an appealing alternative, especially in early-stage basal joint osteoarthritis of the thumb. The low invasiveness of the procedure and early recovery of patients compared with classical procedures such as trapeziectomy, and the superior long-term results compared with classical injection therapy, make this approach feasible as a first-line therapy in early-stage basal joint osteoarthritis of the thumb.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
大多数针对拇指腕掌关节骨关节炎的手术会不可逆地改变或破坏解剖结构。人们对微创替代方案有很高的需求。作者报告了自体脂肪移植治疗拇指腕掌关节骨关节炎的结果。
在一项前瞻性研究中，50例拇指腕掌关节骨关节炎患者在自体脂肪移植后被观察了1年。进行了手动吸脂和离心操作。分析了根据视觉模拟疼痛量表的疼痛评分；捏握和握拳的客观力量；以及治疗前后的手臂、肩部和手部功能障碍问卷评分。
2期患者术前平均疼痛评分为7.7±1.3；6个月后为1.8±1.9，12个月后为2.4±3.1。与3期或4期拇指腕掌关节骨关节炎患者相比，2期骨关节炎患者从该治疗中获益更显著。在力量参数和手臂、肩部和手部功能障碍问卷评分方面也有类似改善。未观察到严重不良事件。
自体脂肪移植是一种有吸引力的替代方法，尤其是在拇指早期基底关节骨关节炎中。与诸如大多角骨切除术等传统手术相比，该手术的低侵入性以及患者的早期恢复，并且与传统注射疗法相比具有更好的长期效果，使得这种方法作为拇指早期基底关节骨关节炎的一线治疗是可行的。
临床问题/证据水平：治疗性，IV级。
