Erne Holger C, Cerny Michael K, Ehrl Denis, Bauer Anna T, Schmauss Verena, Moog Philipp, Broer Peter N, Loew Steffen, Schmauss Daniel
München and Bad Mergentheim, Germany.
From the Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München; the Klinik für Plastische, Rekonstruktive, Hand- und Verbrennungschirurgie, Klinikum Bogenhausen; and the Klinik für Handchirurgie, Caritas Krankenhaus Bad Mergentheim.
Plast Reconstr Surg. 2018 Jan;141(1):119-124. doi: 10.1097/PRS.0000000000003913.
Various operative approaches exist for treatment of trapeziometacarpal joint osteoarthritis. The aim of this study was to compare the results of Lundborg resection arthroplasty with solely autologous fat injection.
Twenty-one patients with symptomatic osteoarthritis of the trapeziometacarpal joint (Eaton-Littler classification stages III/IV) underwent either a Lundborg resection arthroplasty (n = 12) or autologous fat injection into the trapeziometacarpal joint (n = 9). Both groups were comparable regarding demographic and clinical data. Patient records were evaluated retrospectively regarding operative time; Disabilities of the Arm, Shoulder, and Hand questionnaire score; postoperative time until resolution of symptoms; pain level; grip and pinch force; and satisfaction with the treatment.
Both groups had similar length of follow-up of at least 12 months. The duration of the operation was significantly shorter in the fat group (13 ± 5 minutes) compared with the resection group (31 ± 5 minutes) (p < 0.05). The Disabilities of the Arm, Shoulder, and Hand questionnaire score (resection group, 21.9 ± 6.2; fat group, 24.0 ± 5.0) and the pain level at follow-up (resection group, 1.0 ± 0.7; fat group, 2.9 ± 0.8) were comparable (p > 0.05). The time until complete resolution of symptoms was significantly shorter in the fat group (1.7 ± 2.1 months) compared with the resection group (5.7 ± 3.1 months) (p < 0.05). Grip and pinch strength and overall satisfaction with the treatment were comparable (p > 0.05).
Both autologous fat grafting and Lundborg resection arthroplasty resulted in improved function of the operative hand and a clear reduction of symptoms, whereas autologous fat injection seems to have advantages attributable to a shorter time until resolution of symptoms and shorter operative times.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
治疗第一掌腕关节骨关节炎存在多种手术方法。本研究的目的是比较伦德伯格切除术与单纯自体脂肪注射的效果。
21例有症状的第一掌腕关节骨关节炎患者（伊顿 - 利特勒分类III/IV期）接受了伦德伯格切除术（n = 12）或第一掌腕关节自体脂肪注射（n = 9）。两组在人口统计学和临床数据方面具有可比性。对患者记录进行回顾性评估，内容包括手术时间、手臂、肩部和手部功能障碍问卷评分、症状缓解的术后时间、疼痛程度、握力和捏力以及对治疗的满意度。
两组的随访时间均相似，至少为12个月。与切除组（31±5分钟）相比，脂肪组的手术时间明显更短（13±5分钟）（p<0.05）。手臂、肩部和手部功能障碍问卷评分（切除组，21.9±6.2；脂肪组，24.0±5.0）和随访时的疼痛程度（切除组，1.0±0.7；脂肪组，2.9±0.8）具有可比性（p>0.05）。与切除组（5.7±3.1个月）相比，脂肪组症状完全缓解的时间明显更短（1.7±2.1个月）（p<0.05）。握力、捏力和对治疗的总体满意度具有可比性（p>0.05）。
自体脂肪移植和伦德伯格切除术均能改善手术手的功能并明显减轻症状，而自体脂肪注射似乎具有优势，症状缓解时间更短且手术时间更短。
临床问题/证据水平：治疗性，III级
