Papatheodorou Loukia K, Winston Jonathan D, Bielicka Deidre L, Rogozinski Benjamin J, Lourie Gary M, Sotereanos Dean G
Department of Orthopaedic Surgery, Orthopaedic Specialists-UPMC, the University of Pittsburgh, Pittsburgh, PA.
Department of Orthopaedic Surgery, Atlanta Medical Center, Atlanta, GA.
J Hand Surg Am. 2017 Dec;42(12):1032.e1-1032.e7. doi: 10.1016/j.jhsa.2017.07.015. Epub 2017 Sep 6.
To evaluate the outcome of revision surgery for failed thumb carpometacarpal (CMC) arthroplasty.
We retrospectively analyzed 32 patients with failed thumb CMC arthroplasty. The primary reason for revision was pain caused by metacarpal subsidence. Revision surgery included soft tissue interposition and distraction pinning to address the metacarpal subsidence. Additional ligament reconstruction was performed in patients with thumb instability. Eight patients required additional metacarpophalangeal joint fusion for concomitant joint hyperextension. Eleven required additional partial excision of the trapezoid for concomitant scaphotrapezoidal joint arthritis. All patients were evaluated clinically and radiographically.
Mean follow-up was 57 months (range, 24-121 months). Pain levels evaluated by visual analog scale were significantly reduced in all patients after revision surgery. Mean grip strength and key pinch strength significantly increased. Twenty-seven patients achieved good functional results; those for 5 patients were fair.
This study showed that revision surgery with distraction pinning and soft tissue interposition with or without ligament reconstruction was an effective treatment for failed CMC arthroplasty of the thumb.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
评估拇指腕掌关节（CMC）置换术失败后的翻修手术效果。
我们回顾性分析了32例拇指CMC置换术失败的患者。翻修的主要原因是掌骨下沉引起的疼痛。翻修手术包括软组织置入和牵张穿针以解决掌骨下沉问题。对于拇指不稳定的患者，进行了额外的韧带重建。8例患者因合并掌指关节过伸需要额外进行掌指关节融合。11例患者因合并舟大多角关节关节炎需要额外进行大多角骨部分切除。所有患者均进行了临床和影像学评估。
平均随访57个月（范围24 - 121个月）。翻修手术后，所有患者通过视觉模拟量表评估的疼痛程度均显著降低。平均握力和捏力显著增加。27例患者获得了良好的功能结果；5例患者的结果为尚可。
本研究表明，采用牵张穿针和软组织置入并辅以或不辅以韧带重建的翻修手术是治疗拇指CMC置换术失败的有效方法。
研究类型/证据水平：治疗性IV级。
