Jiménez-Díaz Verónica, Cecilia-López David, Porras-Moreno Miguel Ángel, Muñoz-Sánchez Gema, García-Lamas Lorena, Jara-Sánchez Fernando
7th Floor Department of Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Avda. Córdoba s/n, 28041, Madrid, Spain.
Eur J Orthop Surg Traumatol. 2017 Oct;27(7):909-915. doi: 10.1007/s00590-017-1973-1. Epub 2017 May 13.
To assess the long-term results of trapeziometacarpal arthrodesis using a quadrangular plate, regarding clinical, radiological and functional outcomes, as well as development of complications.
From 2005 to 2015, 70 patients were treated at our institution for primary osteoarthrosis of thumb carpometacarpal joint performing a trapeziometacarpal arthrodesis. A total of 85 arthrodesis were carried out using a titanium quadrangular plate (Proflyle plate, Stryker, Kalamazoo MI, USA), without grafting in any case. Pre- and postoperative functional data were assessed at the outpatient clinics using DASH, MWS and VAS. All patients were asked for their ability to perform basic daily activities before and after surgery. All patients were also asked about satisfaction and their return to their jobs after surgery. Pre- and postoperative radiological data were also assessed.
There were 59 females and 11 males with an average age of 55 years (range 44-60). In 66 cases arthrodesis was carried out in the dominant hand, in 45 cases the right thumb was involved, and in 40 the left thumb was involved; in 15 cases arthrodesis was carried out bilaterally. Preoperative average DASH score was 64 (range 50-85), postoperative average score was 25 (range 5-61). Regarding MWS, 51 patients obtained excellent results, 15 patients obtained good results and 4 patients referred poor results. The preoperative average score of VAS was 6 (range 5-10), which decrease to an average of 2 (range 0-3) after surgery; all those differences were statistically significant. All patients reported a mild loss of motion; however, all of them reported improvement to carry out daily activities. There were four cases of nonunion because of failure of fixation and two cases with dysesthetic scar. There was no development of osteoarthritis in adjacent joints. The average follow-up was 60 months.
The use of quadrangular plates for arthrodesis of the trapeziometacarpal joint is a safety and reproducible technique with a low rate of complications. Arthrodesis decreases pain and improves function in patients with primary osteoarthritis of the thumb carpometacarpal joint; in spite of a mild loss of motion, patients are satisfied with this procedure.
评估使用四边形钢板进行大多角骨-第一掌骨融合术的长期效果，包括临床、影像学和功能结果以及并发症的发生情况。
2005年至2015年，我院对70例因拇指腕掌关节原发性骨关节炎而行大多角骨-第一掌骨融合术的患者进行了治疗。共使用钛制四边形钢板（Proflyle钢板，史赛克公司，美国密歇根州卡拉马祖）进行了85例融合术，均未进行植骨。术前和术后的功能数据在门诊使用DASH、MWS和VAS进行评估。所有患者均被询问手术前后进行基本日常活动的能力。所有患者还被问及对手术的满意度以及术后恢复工作的情况。术前和术后的影像学数据也进行了评估。
患者中女性59例，男性11例，平均年龄55岁（范围44 - 60岁）。66例融合术在优势手进行，45例累及右手拇指，40例累及左手拇指；15例进行了双侧融合术。术前平均DASH评分为64（范围50 - 85），术后平均评分为25（范围5 - 61）。关于MWS，51例患者获得优秀结果，15例患者获得良好结果，4例患者结果较差。术前VAS平均评分为6（范围5 - 10），术后降至平均2（范围0 - 3）；所有这些差异均具有统计学意义。所有患者均报告活动度有轻度丧失；然而，他们均报告进行日常活动的能力有所改善。有4例因固定失败导致骨不连，2例出现感觉异常性瘢痕。相邻关节未发生骨关节炎。平均随访时间为60个月。
使用四边形钢板进行大多角骨-第一掌骨融合术是一种安全且可重复的技术，并发症发生率低。融合术可减轻拇指腕掌关节原发性骨关节炎患者的疼痛并改善功能；尽管活动度有轻度丧失，但患者对该手术满意。
