Duncan Scott F M, Smith Anthony A, Renfree Kevin J, Dunbar Ross M, Merritt Marianne V
* Department of Orthopedics, Boston University, Boston, MA, USA.
‡ Departments of Surgery, Mayo Clinic, Scottsdale, AZ, USA.
J Hand Surg Asian Pac Vol. 2018 Mar;23(1):26-32. doi: 10.1142/S2424835518500042.
Most hand surgeons use a dorsal approach for proximal interphalangeal (PIP) joint implant arthroplasty. However, a volar approach offers the advantage of no disturbance to the extensor mechanism, thus allowing early initiation of active range of motion. We examined our results in patients who underwent PIP joint arthroplasty via a volar approach.
Using a retrospective chart review, we evaluated the outcomes of patients undergoing PIP joint arthroplasty through a volar approach between 2001 and 2005 by 3 fellowship-trained hand surgeons at our institution. The indication for surgery was PIP joint pain with radiographic evidence of joint destruction. Variables included implant type, diagnosis, affected digit(s), preoperative and postoperative range of motion, and complications. Hand therapy was initiated on postoperative day 3 or 4.
Over the 5 years, 25 PIP joints were replaced in 18 women and 2 men with the volar approach. Replacements consisted of 14 surface replacement prostheses, 9 pyrocarbon prostheses, and 2 silicone prostheses. The average age of patients at prosthesis implantation was 64 years (range, 39-75 years). Prostheses were placed in 1 index, 12 long, 7 ring, and 5 small digits. Average follow-up period was 33 months (range, 24-69 months). Preoperative diagnoses were osteoarthritis (14), rheumatoid arthritis (4), and posttraumatic arthritis (2). Preoperative total arc of motion averaged 42° (range, 0° extension to 80° flexion); postoperative total arc of motion averaged 56° (range, -10° extension to 90° flexion). Complications comprised 1 swan neck deformity, 1 deep infection, 1 dislocation (early), and 2 loose implants with flexion contractures. Seventeen patients had minimal or no pain at their last follow-up visit.
PIP joint arthroplasty can be successfully implemented through a volar approach with various implant types and has outcomes similiar to the published results of the dorsal approach.
大多数手外科医生在近端指间（PIP）关节置换术中采用背侧入路。然而，掌侧入路具有不干扰伸肌机制的优势，从而能够早期开始主动活动范围训练。我们研究了采用掌侧入路进行PIP关节置换术患者的治疗结果。
通过回顾性病历审查，我们评估了2001年至2005年间在我们机构由3名经过专科培训的手外科医生采用掌侧入路进行PIP关节置换术患者的治疗结果。手术指征为PIP关节疼痛且有影像学证据显示关节破坏。变量包括植入物类型、诊断、受累手指、术前和术后活动范围以及并发症。术后第3天或第4天开始手部康复治疗。
在这5年期间，18名女性和2名男性采用掌侧入路置换了25个PIP关节。置换物包括14个表面置换假体、9个热解碳假体和2个硅胶假体。假体植入时患者的平均年龄为64岁（范围39 - 75岁）。假体植入的手指包括1个示指、12个中指、7个环指和5个小指。平均随访期为33个月（范围24 - 69个月）。术前诊断为骨关节炎（14例）、类风湿关节炎（4例）和创伤后关节炎（2例）。术前总活动弧平均为42°（范围从伸直0°到屈曲80°）；术后总活动弧平均为56°（范围从伸直 - 10°到屈曲90°）。并发症包括1例鹅颈畸形、1例深部感染、1例早期脱位以及2例假体松动伴屈曲挛缩。17名患者在最后一次随访时疼痛轻微或无疼痛。
PIP关节置换术通过掌侧入路采用各种植入物类型均可成功实施，其结果与已发表的背侧入路结果相似。
