Van Royen Kjell, Kestens Bart, Van Laere Sven, Goubau Jean, Goorens Chul Ki
Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Department of Orthopaedics and Traumatology, Hagelandse Orthopedische Praktijk, Regionaal Ziekenhuis Tienen, Tienen, Belgium.
J Wrist Surg. 2018 Nov;7(5):394-398. doi: 10.1055/s-0038-1661421. Epub 2018 Jul 2.
Proximal migration of the first metacarpal can be seen after total trapeziectomy and various techniques have been described to prevent this subsidence. We hypothesized the insertion of a poly-L/D-lactide spacer to prevent proximal migration of the first metacarpal without the need of an additional ligament reconstruction, allowing early mobilization and less demanding rehabilitation. Ten thumbs were treated with a total trapeziectomy and insertion of a poly-L/D-lactide scaffold. Clinical and radiological evaluation was performed after 6 months and 1 year. Patient satisfaction, pain, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, mobility of the thumb, and strength were assessed. Pain according to the visual analog scale decreased ( = 0.01) and QuickDASH score decreased ( = 0.02) significantly after 1 year. Radiological evaluation after 12 months showed a collapse of the scaphometacarpal distance of 45% ( = 0.01). Osteolysis of the distal scaphoid pole and/or proximal metacarpal was seen in 6 out of 10 cases. Because of the osteolysis, the use of the poly-L/D-lactide scaffold was discontinued in our practice. In this limited series, total trapeziectomy with the use of the poly-L/D-lactide scaffold provides significant pain reduction and improvement of overall function. Radiographic evaluation shows significant collapse of the scaphometacarpal distance after 1 year and frequent signs of osteolysis. We do not encourage the use of the poly-L/D-lactide scaffold with total trapeziectomy before long-term clinical and radiological follow-ups of the osteolysis are available.
在全舟状骨切除术后可见第一掌骨近端移位，并且已经描述了多种防止这种下沉的技术。我们假设插入聚-L/D-丙交酯间隔物可防止第一掌骨近端移位，而无需额外的韧带重建，从而实现早期活动并减少康复需求。对10例拇指进行了全舟状骨切除术并插入聚-L/D-丙交酯支架。在6个月和1年后进行了临床和影像学评估。评估了患者满意度、疼痛、手臂、肩部和手部快速残疾量表（QuickDASH）评分、拇指活动度和力量。1年后，根据视觉模拟量表的疼痛明显减轻（P = 0.01），QuickDASH评分明显降低（P = 0.02）。12个月后的影像学评估显示舟掌距离塌陷45%（P = 0.01）。10例中有6例出现舟状骨远端极和/或第一掌骨近端的骨质溶解。由于骨质溶解，我们在实践中停止使用聚-L/D-丙交酯支架。在这个有限的系列研究中，使用聚-L/D-丙交酯支架进行全舟状骨切除术可显著减轻疼痛并改善整体功能。影像学评估显示1年后舟掌距离明显塌陷，且频繁出现骨质溶解迹象。在获得关于骨质溶解的长期临床和影像学随访结果之前，我们不鼓励在全舟状骨切除术中使用聚-L/D-丙交酯支架。
