Logli Anthony L, Twu Jonathan, Bear Brian J, Lindquist Jonathan R, Schoenfeldt Theodore L, Korcek Kenneth J
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
Department of Orthopaedic Surgery and Rehabilitation Medicine, Chicago, IL.
J Hand Surg Am. 2018 Apr;43(4):384.e1-384.e7. doi: 10.1016/j.jhsa.2017.10.016. Epub 2017 Nov 11.
To determine if arthroscopic partial trapeziectomy (APT) and soft tissue interposition arthroplasty is an effective treatment for symptomatic trapeziometacarpal arthritis.
We retrospectively evaluated 30 consecutive patients with symptomatic isolated trapeziometacarpal arthritis, Eaton-Littler stages II and III. Treatment consisted of an APT with soft tissue interposition utilizing an acellular dermal matrix as the interposition material. At a minimum of 6 months and 5 years after surgery, Numeric Pain Rating Scale (NPRS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), grip strength, oppositional and appositional pinch strengths, arthroplasty space, and thumb range of motion (ROM) were evaluated.
At 6-month minimum follow-up, 30 of 30 patients reported a significant reduction in pain; preoperative NPRS averaged 8.2 and decreased to 1.3. Average QuickDASH score was 17.5. Twenty-nine of 30 thumbs could adduct fully in the plane of the palm. Twenty-four patients were available for 5-year minimum follow-up. Average QuickDASH score measured 8.9, whereas pain (mean NPRS, 0.8), grip, and pinch strengths were not significantly different from the 6-month assessment. There was a small reduction in arthroplasty space at 5-year follow-up that did not affect clinical outcome measures. Thumb ROM did not change between the 6-month and the 5-year follow-up. Complications were rare.
An APT with interposition arthroplasty utilizing an acellular dermal matrix as the interposition material is a safe and reliable procedure with satisfactory outcomes at short- and long-term follow-up. Pain, strength, QuickDASH, and ROM do not significantly change between the 6-month and the 5-year follow-up.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
确定关节镜下部分大多角骨切除术（APT）及软组织置入关节成形术是否是治疗有症状的大多角骨-第一掌骨关节关节炎的有效方法。
我们回顾性评估了30例连续的有症状的孤立性大多角骨-第一掌骨关节关节炎患者，伊顿-利特勒分期为II期和III期。治疗方法为采用脱细胞真皮基质作为置入材料进行APT及软组织置入。在术后至少6个月和5年时，评估数字疼痛评分量表（NPRS）、手臂、肩部和手部快速残疾评定量表（QuickDASH）、握力、对掌和对指捏力、关节成形间隙以及拇指活动范围（ROM）。
在至少6个月的随访中，30例患者中有30例报告疼痛显著减轻；术前NPRS平均为8.2，降至1.3。平均QuickDASH评分为17.5。30例拇指中有29例能够在手掌平面内完全内收。24例患者可进行至少5年的随访。平均QuickDASH评分为8.9，而疼痛（平均NPRS，0.8）、握力和捏力与6个月评估时无显著差异。在5年随访时关节成形间隙略有减小，但不影响临床结局指标。6个月和5年随访之间拇指ROM未发生变化。并发症罕见。
采用脱细胞真皮基质作为置入材料的APT及置入关节成形术是一种安全可靠的手术方法，短期和长期随访结果均令人满意。6个月和5年随访之间疼痛、力量、QuickDASH和ROM无显著变化。
研究类型/证据水平：治疗性IV级。
