Hippensteel K J, Calfee Ryan, Dardas Agnes Z, Gelberman Richard, Osei Daniel, Wall Lindley
Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.
Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.
J Hand Surg Am. 2017 Sep;42(9):685-692. doi: 10.1016/j.jhsa.2017.05.018. Epub 2017 Jun 23.
To compare standardized functional and patient-reported early outcomes following trapeziometacarpal arthrodesis (TMA) using a locking cage plate construct with trapezial excision, ligament reconstruction, and tendon interposition (LRTI).
This prospective cohort enrolled 50 consecutive patients with trapeziometacarpal osteoarthritis undergoing TMA or LRTI. Demographic data, objective measurements, Sollerman function testing, and patient-reported outcomes were collected before surgery and at various time intervals up to 12 months after surgery. The study was powered to detect a minimally clinically important difference on the Michigan Hand Questionnaire between groups at 12 months. To account for selection bias, we performed between-group statistical analysis of the magnitude of change from preoperative to postoperative data. All complications were recorded.
There were no significant differences in the amount of change in grip or pinch strength, patient-reported outcomes, or functional hand testing between TMA and LRTI. The TMA group had significantly increased thumb tip opposition distance. The TMA group was complicated by a 26% overall nonunion rate of which 8% were symptomatic. The LRTI group (Wagner incision) had a significantly increased incidence of superficial branch of the radial nerve paresthesia. The incidence of complications was similar between operative groups, but revision surgery was more common after TMA.
Compared with LRTI, TMA failed to demonstrate superior improvement in strength, standardized functional performance, or patient-reported function and is associated with an increased likelihood of revision surgery in the first 12 months. Trapeziometacarpal arthrodesis with a locking plate and screw construct does not ensure union, although most radiographic nonunions were asymptomatic. Wagner incisions are associated with a significantly increased incidence of superficial branch of the radial nerve paresthesia compared with dorsal trapeziometacarpal exposure.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
比较使用锁定钢板固定的大多角骨-掌骨关节融合术（TMA）与大多角骨切除、韧带重建和肌腱植入术（LRTI）后的标准化功能及患者报告的早期疗效。
这项前瞻性队列研究纳入了50例连续接受TMA或LRTI治疗的大多角骨-掌骨关节炎患者。收集了人口统计学数据、客观测量结果、索勒曼功能测试以及患者报告的术前和术后长达12个月不同时间间隔的疗效。该研究旨在检测两组患者术后12个月时密歇根手功能问卷上最小临床重要差异。为了考虑选择偏倚，我们对术前至术后数据变化幅度进行了组间统计分析。记录所有并发症。
TMA和LRTI在握力或捏力变化量、患者报告的疗效或手部功能测试方面无显著差异。TMA组拇指尖对掌距离显著增加。TMA组总体骨不连发生率为26%，其中8%有症状。LRTI组（瓦格纳切口）桡神经浅支感觉异常发生率显著增加。手术组间并发症发生率相似，但TMA术后翻修手术更常见。
与LRTI相比，TMA在力量、标准化功能表现或患者报告的功能方面未显示出更优的改善，且与术后前12个月内翻修手术可能性增加相关。使用锁定钢板和螺钉固定的大多角骨-掌骨关节融合术不能确保骨愈合，尽管大多数影像学骨不连无症状。与背侧大多角骨-掌骨入路相比，瓦格纳切口与桡神经浅支感觉异常发生率显著增加相关。
研究类型/证据水平：治疗性II级
