Trumble Thomas E, Heaton Dennis J
1 Bellevue Hand Institute, WA, USA.
2 Pacific Northwest University of Health Sciences, Yakima, WA, USA.
Hand (N Y). 2017 May;12(3):290-296. doi: 10.1177/1558944716662020. Epub 2016 Aug 3.
The dorsal approach to the proximal interphalangeal (PIP) joint provides the advantage of improved visualization of the articular surface, while the disadvantage of a dorsal approach is the disruption of the central slip and extensor mechanism requiring a delay in range of motion exercises. A volar approach keeps the central slip and extensor mechanism intact, allowing for early range of motion. The goal of this study was to evaluate patient outcomes of surface replacement (SR) PIP joint arthroplasty performed through a volar approach.
Twenty-one patients were evaluated with primary osteoarthritis of a single PIP joint and underwent SR arthroplasty using the Stryker SR PIP joint implants. Patients included in this study were exclusively treated through a volar approach. Preoperative range of motion, coronal plan deformity, Disabilities of the Arm, Shoulder and Hand (DASH), and patient satisfaction were measured and compared with postoperative measurements using a paired Student t test.
The average length of follow-up was 34 months (± 9 months). Postoperative arc of motion for the PIP and distal interphalangeal (DIP) joints measured 87° (±12°) and 36° (±11°), respectively. The average improvement in PIP arc of motion was 58°, DASH score measured 14 (±5), satisfaction measured 4 (±1), and coronal plane deviation measured 2° (±2°). No evidence of implant subsidence was found on postoperative radiographs. Four patients required an extensor tendon tenolysis, and 1 patient suffered a superficial surgical site infection.
SR arthroplasty, when performed through a volar approach, allows for early range of motion and greater improvements in arc of motion, DASH score, and patient satisfaction.
近端指间关节（PIP）的背侧入路具有能更好地观察关节面的优势，而背侧入路的缺点是会破坏中央束和伸肌机制，这需要延迟进行活动度练习。掌侧入路可保持中央束和伸肌机制完整，从而允许早期进行活动度练习。本研究的目的是评估通过掌侧入路进行表面置换（SR）PIP关节置换术的患者预后。
对21例单个PIP关节原发性骨关节炎患者进行评估，并使用史赛克SR PIP关节植入物进行SR关节置换术。本研究纳入的患者均仅通过掌侧入路进行治疗。术前测量活动度、冠状面畸形、上肢、肩部和手部功能障碍（DASH）以及患者满意度，并使用配对t检验与术后测量结果进行比较。
平均随访时间为34个月（±9个月）。PIP关节和远端指间关节（DIP）术后的活动弧度分别为87°（±12°）和36°（±11°）。PIP关节活动弧度的平均改善为58°，DASH评分为14（±5），满意度评分为4（±1），冠状面偏差为2°（±2°）。术后X线片未发现植入物下沉的迹象。4例患者需要进行伸肌腱松解术，1例患者发生浅表手术部位感染。
通过掌侧入路进行SR关节置换术可实现早期活动度，并且在活动弧度、DASH评分和患者满意度方面有更大改善。
