近端指间关节置换术不同植入物和手术方法的系统评价
A Systematic Review of Different Implants and Approaches for Proximal Interphalangeal Joint Arthroplasty.
作者信息
Yamamoto Michiro, Malay Sunitha, Fujihara Yuki, Zhong Lin, Chung Kevin C
机构信息
Ann Arbor, Mich.; and Nagoya, Japan.
From the Section of Plastic Surgery, Department of Surgery, and the Section of Plastic and Reconstructive Surgery, University of Michigan Health System; the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School; and the Department of Hand Surgery, Nagoya University Graduate School of Medicine.
出版信息
Plast Reconstr Surg. 2017 May;139(5):1139e-1151e. doi: 10.1097/PRS.0000000000003260.
BACKGROUND
Outcomes after implant arthroplasty for primary degenerative and posttraumatic osteoarthritis of the proximal interphalangeal joint were different according to the implant design and surgical approach. The purpose of this systematic review was to evaluate outcomes of various types of implant arthroplasty for proximal interphalangeal joint osteoarthritis, with an emphasis on different surgical approaches.
METHODS
The authors searched all available literature in the PubMed and EMBASE databases for articles reporting on outcomes of implant arthroplasty for proximal interphalangeal joint osteoarthritis. Data collection included active arc of motion, extension lag, and complications. The authors combined the data of various types of surface replacement arthroplasty into one group for comparison with silicone arthroplasty.
RESULTS
A total of 849 articles were screened, yielding 40 studies for final review. The mean postoperative arc of motion and the mean gain in arc of motion of silicone implant with the volar approach were 58 and 17 degrees, respectively, which was greater than surface replacement implant with the dorsal approach at 51 and 8 degrees, respectively. The mean postoperative extension lag of silicone implant with the volar approach and surface replacement with the dorsal approach was 5 and 14 degrees, respectively. The revision rate of silicone implant with the volar approach and surface replacement with the dorsal approach was 6 percent and 18 percent at a mean follow-up of 41.2 and 51 months, respectively.
CONCLUSION
Silicone implant with the volar approach showed the best arc of motion, with less extension lag and fewer complications after surgery among all the implant designs and surgical approaches.
背景
根据植入物设计和手术入路的不同，近端指间关节原发性退行性和创伤后骨关节炎的植入关节成形术的结果有所差异。本系统评价的目的是评估各种类型的近端指间关节骨关节炎植入关节成形术的结果，重点关注不同的手术入路。
方法
作者检索了PubMed和EMBASE数据库中所有关于近端指间关节骨关节炎植入关节成形术结果的文献。数据收集包括活动弧度、伸展滞后和并发症。作者将各种类型的表面置换关节成形术的数据合并为一组，与硅胶关节成形术进行比较。
结果
共筛选出849篇文章，最终纳入40项研究进行综述。掌侧入路硅胶植入物术后平均活动弧度和活动弧度平均增加量分别为58度和17度，大于背侧入路表面置换植入物的51度和8度。掌侧入路硅胶植入物和背侧入路表面置换术后的平均伸展滞后分别为5度和14度。掌侧入路硅胶植入物和背侧入路表面置换的翻修率在平均随访41.2个月和51个月时分别为6%和18%。
结论
在所有植入物设计和手术入路中，掌侧入路硅胶植入物的活动弧度最佳，术后伸展滞后更小，并发症更少。
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