Yao Jeffrey, Cheah Andre Eu-Jin
Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA.
Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA; Department of Hand and Reconstructive Microsurgery, National University Hospital, National University Health System, Singapore.
J Hand Surg Am. 2017 Jul;42(7):569.e1-569.e11. doi: 10.1016/j.jhsa.2017.03.011. Epub 2017 Apr 12.
Suture button suspensionplasty (SBS) has been used to treat thumb carpometacarpal joint osteoarthritis (CMC joint OA). Although promising short-term outcomes have been reported, no outcomes beyond 4 years have been published. The aim of this article is to report intermediate outcomes of SBS.
We reviewed the charts of 14 patients who underwent 16 SBS procedures for symptomatic thumb CMC joint OA. We recorded demographic data, preoperative Eaton stage, length of follow-up, Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire scores, as well as pinch strength, grip strength, range of motion, and metacarpal subsidence. Operative time and postoperative complications were documented.
Average age was 64 years. There were 12 women and 2 men. Preoperative Eaton stages were III and IV in 8 thumbs each. Mean operative time was 93 minutes. Mean follow-up was 64 months with mean Quick-Disabilities of the Arm, Shoulder, and Hand score improvement of 58.2. Mean palmar and radial abduction were 105% and 97%, respectively, of the nonsurgical thumb. Kapandji scores for all operated thumbs were either 9 or 10. Pinch and grip strength were 107% and 102%, respectively, of the nonsurgical side. Mean trapezial space height was 71%. One patient underwent removal of a symptomatic implant and 2 patients had transient neuropraxia of the dorsal radial sensory nerve.
Favorable outcomes (improvement in range of motion and pain relief) of SBS remain durable over time. Our results show that improvement in strength may also be expected over time when using SBS after trapeziectomy for the treatment of thumb CMC joint OA.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
缝线纽扣悬吊成形术(SBS)已用于治疗拇指腕掌关节骨关节炎(CMC关节OA)。尽管已有报道显示其短期疗效良好,但尚无超过4年的疗效报道。本文旨在报告SBS的中期疗效。
我们回顾了14例因拇指CMC关节OA有症状而接受16次SBS手术患者的病历。我们记录了人口统计学数据、术前伊顿分期、随访时间、手臂、肩部和手部快速残疾问卷评分,以及捏力、握力、活动范围和掌骨沉降情况。记录手术时间和术后并发症。
平均年龄为64岁。女性12例,男性2例。术前8个拇指的伊顿分期为III期和IV期。平均手术时间为93分钟。平均随访64个月,手臂、肩部和手部快速残疾评分平均改善58.2。平均掌侧外展和桡侧外展分别为非手术拇指的105%和97%。所有手术拇指的卡潘迪评分均为9或10。捏力和握力分别为非手术侧的107%和102%。平均大多角骨间隙高度为71%。1例患者取出了有症状的植入物,2例患者出现桡神经背侧感觉支短暂性神经失用。
SBS的良好疗效(活动范围改善和疼痛缓解)随时间推移仍持久。我们的结果表明,对于拇指CMC关节OA,在大多角骨切除术后使用SBS治疗,随着时间推移也可能预期力量会有所改善。
研究类型/证据水平:治疗性IV级。