与大多角骨切除术和韧带成形术相比，大多角骨-掌骨假体是否能提供更好的掌指稳定性？
Do trapeziometacarpal prosthesis provide better metacarpophalangeal stability than trapeziectomy and ligamentoplasty?
作者信息
Degeorge Benjamin, Dagneaux Louis, Andrin Julien, Lazerges Cyril, Coulet Bertrand, Chammas Michel
机构信息
Unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, département de chirurgie orthopédique, CHU de Lapeyronie, 191, avenue du Doyen Gaston-Giraud, 34295 Montpellier, France.
Unité de chirurgie du membre inférieur, département de chirurgie orthopédique, CHU de Lapeyronie, 191, avenue du Doyen Gaston-Giraud, 34295 Montpellier, France.
出版信息
Orthop Traumatol Surg Res. 2018 Nov;104(7):1095-1100. doi: 10.1016/j.otsr.2018.07.008. Epub 2018 Aug 11.
BACKGROUND
No surgical management is better than another regarding functional recovery for trapeziometacarpal joint osteoarthritis. Metacarpophalangeal (MCP) hyperextension, directly due to the shortening of thumb height, appears to be a factor of poor prognosis.
HYPOTHESIS
MCP hyperextension can be corrected by implantation of a trapeziometacarpal prosthesis (TMP), as opposed to trapeziectomy and ligamentoplasty (TL), and pinch strength is greater with TMP in this indication.
MATERIAL AND METHODS
Sixty-nine patients (41 TMP and 28 TL) were retrospectively evaluated. The following were evaluated: pain, mobility of the metacarpophalangeal joints, palmar grip and pinch strength. Thumb height was measured on radiographs as a post/preoperative ratio.
RESULTS
The mean follow-up was 20 months (6-38). The TMP group showed greater reduction of the metacarpophalangeal hyperextension in all hyperextension groups, especially hypertension >30°, compared with TL. The TMP group provided significant greater pinch strength in all the subgroups with preoperative MCP hyperextension. Patient with postoperative MCP hyperextension had a significant lower grip and pinch strength compared with patient without MCP hyperextension. Radiographic analysis showed that thumb height changes were related to the degree of preoperative hyperextension. Postoperatively, patients with postoperative MCP hyperextension had a significant lower thumb height than patient without MCP hyperextension.
DISCUSSION
Metacarpophalangeal hyperextension appears to be a factor of poor prognosis for surgical treatment of trapeziometacarpal osteoarthritis when it is not managed. TMP provides better metacarpophalangeal stabilization by restoring thumb length and would avoid surgery on the metacarpophalangeal joint. TMP may be recommended in patients having symptomatic trapeziometacarpal joint osteoarthritis and MCP joint hyperextension.
LEVEL OF EVIDENCE
III, retrospective observational case control study.
背景
对于大多角骨-第一掌骨关节骨关节炎的功能恢复而言，没有哪种手术治疗方式优于其他方式。直接由拇指高度缩短所致的掌指关节（MCP）过度伸展似乎是预后不良的一个因素。
假设
与大多角骨切除术和韧带成形术（TL）相反，植入大多角骨-第一掌骨假体（TMP）可纠正MCP过度伸展，并且在此适应证中使用TMP时捏力更大。
材料与方法
对69例患者（41例行TMP手术，28例行TL手术）进行回顾性评估。评估内容包括：疼痛、掌指关节活动度、握力和捏力。在X线片上测量拇指高度，并计算术后/术前比值。
结果
平均随访时间为20个月（6 - 38个月）。与TL组相比，TMP组在所有过度伸展组中，尤其是过度伸展>30°的患者中，MCP过度伸展的改善更为明显。在所有术前存在MCP过度伸展的亚组中，TMP组的捏力明显更大。术后存在MCP过度伸展的患者与无MCP过度伸展的患者相比，握力和捏力明显更低。影像学分析表明，拇指高度变化与术前过度伸展程度有关。术后，存在MCP过度伸展的患者拇指高度明显低于无MCP过度伸展的患者。
讨论
当未对MCP过度伸展进行处理时，它似乎是大多角骨-第一掌骨关节骨关节炎手术治疗预后不良的一个因素。TMP通过恢复拇指长度可提供更好的掌指关节稳定性，并可避免对掌指关节进行手术。对于有症状的大多角骨-第一掌骨关节骨关节炎和MCP关节过度伸展的患者，可推荐使用TMP。
证据水平
III级，回顾性观察性病例对照研究。
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