D'Agostino Priscilla, Dourthe Benjamin, Kerkhof Faes, Vereecke Evie E, Stockmans Filip
Muscles & Movement, Department of Development and Regeneration, Biomedical Sciences Group, Kulak, Belgium; Louise Hand Clinic, Brussels, Belgium; Europe Clinic, St-Elisabeth Clinic, Brussels, Belgium.
Muscles & Movement, Department of Development and Regeneration, Biomedical Sciences Group, Kulak, Belgium.
J Hand Surg Am. 2018 Apr;43(4):382.e1-382.e10. doi: 10.1016/j.jhsa.2017.10.011. Epub 2017 Nov 14.
To quantify the effect of osteoarthritis (OA) and total trapeziometacarpal (TMC) joint replacement on thumb kinematics during the primary physiological motions of the thumb.
We included 4 female patients with stage III TMC OA. A computed tomography-based markerless method was used to quantify the 3-dimensional thumb kinematics in patients before and after TMC joint replacement surgery with the Arpe implant.
Trapeziometacarpal OA led to a marked decrease of internal rotation and abduction of the first metacarpal (MC1) during thumb flexion and a decrease of MC1 adduction during thumb adduction. As a compensatory phenomenon, the trapezium displayed increased abduction. The absence of MC1 translation in the ball-and-socket implant seems to induce a decrease of MC1 adduction as well as a decrease of trapezium adduction during thumb adduction, compared with OA and healthy joints. Implant replacement displayed an unchanged MC1 flexion during thumb flexion and seemed to slightly increase MC1 axial rotation during thumb flexion and adduction. Abduction and adduction of the MC1 are limited and compensated by this somewhat increased axial rotation, allowing more efficient thumb opposition.
The study highlights that advanced TMC OA mainly restricts the MC1 mobility. We also showed that, whereas total joint arthroplasty is able to restore thumb function, it cannot fully replicate the kinematics of the healthy TMC joint.
The quantification of TMC joint kinematics in OA and implanted patients is essential to improve our understanding of TMC OA as well as to enhance the functionality of implant designs.
量化骨关节炎（OA）和全大多角骨-第一掌骨（TMC）关节置换对拇指主要生理运动过程中拇指运动学的影响。
我们纳入了4例III期TMC OA的女性患者。采用基于计算机断层扫描的无标记方法，对使用Arpe植入物进行TMC关节置换手术前后患者的三维拇指运动学进行量化。
大多角骨-第一掌骨关节OA导致拇指屈曲时第一掌骨（MC1）内旋和外展明显减少，拇指内收时MC1内收减少。作为一种代偿现象，大多角骨外展增加。与OA和健康关节相比，球窝植入物中MC1无平移似乎导致拇指内收时MC1内收减少以及大多角骨内收减少。植入物置换后拇指屈曲时MC1屈曲不变，拇指屈曲和内收时MC1轴向旋转似乎略有增加。MC1的外展和内收受到限制，并通过这种略有增加的轴向旋转得到代偿，从而使拇指对掌更有效。
该研究强调晚期TMC OA主要限制MC1的活动度。我们还表明，虽然全关节置换术能够恢复拇指功能，但它不能完全复制健康TMC关节的运动学。
量化OA患者和植入患者的TMC关节运动学对于增进我们对TMC OA的理解以及提高植入物设计的功能性至关重要。
