Moreno Rodrigo, Bhandari Laxminarayan
Christine M. Kleinert Institute, University of Louisville, Louisville, KY.
Tech Hand Up Extrem Surg. 2019 Mar;23(1):10-13. doi: 10.1097/BTH.0000000000000214.
Arthritis of scaphotrapeziotrapezoid joint is common and can be seen in association with first carpal metacarpal (CMC) arthritis. Untreated scaphotrapeziotrapezoid arthritis may be a cause of residual pain after CMC arthroplasty. There are various treatment options described in the literature ranging from arthrodesis, resection arthroplasty, interpositional arthroplasty, and implant arthroplasty. We describe a novel technique of flexor carpi radialis (FCR) tendon interposition to tackle this condition. Our common treatment for CMC arthritis is trapezium resection with ligament reconstruction and tendon interposition with half of the FCR. With this procedure, through the same exposure, the proximal part of the trapezoid is resected. An anchor is placed into the trapezoid and the sutures are passed through a remnant of the FCR. Thus the FCR is pulled in between the scaphoid and the trapezoid and secured in place. We performed this procedure in 13 hands with average follow-up of 36 months. All patients were satisfied with the procedure and were pain free at their last follow-up. The advantage of this procedure is the use of the FCR, which is already available in the field and requires very little additional procedure.
舟大多角小多角关节关节炎很常见，可与第一腕掌（CMC）关节炎同时出现。未经治疗的舟大多角小多角关节炎可能是CMC关节置换术后残留疼痛的一个原因。文献中描述了多种治疗选择，从关节融合术、切除关节成形术、间置关节成形术到植入关节成形术。我们描述了一种新型的桡侧腕屈肌（FCR）肌腱间置技术来处理这种情况。我们治疗CMC关节炎的常用方法是切除大多角骨并进行韧带重建，以及用一半的FCR肌腱进行间置。通过这个手术，在相同的暴露下，切除小多角骨的近端部分。将一个锚钉置入小多角骨，缝线穿过FCR的残余部分。这样FCR就被牵拉到舟骨和小多角骨之间并固定到位。我们对13只手进行了这个手术，平均随访36个月。所有患者对手术都很满意，在最后一次随访时均无疼痛。这个手术的优点是使用了FCR，它在手术区域内已经存在，几乎不需要额外的操作。
