DeGeorge Brent R, Chawla Sagar S, Elhassan Bassem T, Kakar Sanjeev
1 Mayo Clinic, Rochester, MN, USA.
Hand (N Y). 2019 Jan;14(1):66-72. doi: 10.1177/1558944718798850. Epub 2018 Sep 6.
We sought to compare the functional outcomes, radiographic outcomes, and complications of trapeziectomy and flexor carpi radialis (FCR) to abductor pollicis longus (APL) side-to-side tendon transfer with or without suture-button suspensionplasty for thumb basilar joint arthritis.
Patients treated with and without suture-button suspensionplasty were compared over a 6-year period. Data were reviewed for complications and functional outcomes, including grip and pinch strength, range of motion, and visual analog scale (VAS) pain scores. Plain radiographs were independently reviewed at initial presentation and at final follow-up, including proximal phalanx length, trapezial space height, and trapezial height ratio.
Seventy thumb arthroplasties were performed in 70 patients. Trapeziectomy with FCR-APL side-to-side tendon transfer was performed in 39 patients, and trapeziectomy with FCR-APL side-to-side tendon transfer with suture-button suspensionplasty was performed in 31 patients. Mean length of follow-up was 28.4 ± 3.9 and 23.8 ± 2.6 months, respectively. Postoperative grip, oppositional and appositional pinch strength, and VAS pain scores improved compared with preoperative values, but were not significantly different based on suture-button suspensionplasty. Percentage decline in trapezial space ratio was significantly different between groups at 36.7% and 20.4% for procedures with and without suture-button suspensionplasty, respectively indicating that the trapezial space was better maintained within the suture suspension cohort. The incidence of postoperative complications, including surgical site infection, paresthesias, reoperation, complex regional pain syndrome, and symptomatic subsidence, was not significantly different between groups.
Trapeziectomy with FCR to APL side-to-side tendon transfer with and without suture-button suspensionplasty results in comparable improvement in pain, grip strength, and functional parameters. Suture-button suspensionplasty results in significantly greater preservation of trapezial space.
我们旨在比较对于拇指腕掌关节关节炎，单纯大多角骨切除术与桡侧腕屈肌（FCR）至拇长展肌（APL）侧-侧肌腱转位术，以及联合或不联合缝线纽扣悬吊成形术的功能结局、影像学结局和并发症情况。
对6年间接受或未接受缝线纽扣悬吊成形术治疗的患者进行比较。回顾并发症和功能结局数据，包括握力、捏力、活动范围和视觉模拟评分（VAS）疼痛评分。在初次就诊时和最终随访时独立复查X线平片，包括近节指骨长度、大多角骨间隙高度和大多角骨高度比。
70例患者共进行了70例拇指关节成形术。39例患者接受了大多角骨切除术联合FCR-APL侧-侧肌腱转位术，31例患者接受了大多角骨切除术联合FCR-APL侧-侧肌腱转位术及缝线纽扣悬吊成形术。平均随访时间分别为28.4±3.9个月和23.8±2.6个月。与术前值相比，术后握力、对掌和对指捏力以及VAS疼痛评分均有所改善，但基于缝线纽扣悬吊成形术并无显著差异。对于接受和未接受缝线纽扣悬吊成形术的手术，大多角骨间隙比的下降百分比在两组间有显著差异，分别为36.7%和20.4%，这表明在缝线悬吊组中大多角骨间隙得到了更好的维持。两组术后并发症的发生率，包括手术部位感染、感觉异常、再次手术、复杂性区域疼痛综合征和症状性下沉，并无显著差异。
对于拇指腕掌关节关节炎，单纯大多角骨切除术与FCR至APL侧-侧肌腱转位术，无论联合或不联合缝线纽扣悬吊成形术，在疼痛、握力和功能参数方面的改善效果相当。缝线纽扣悬吊成形术能显著更好地保留大多角骨间隙。
