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采用髓内Lync植入物的远侧指间关节融合术:22例前瞻性研究。

Distal interphalangeal joint arthrodesis with the intramedullary Lync implant: Prospective study of 22 cases.

作者信息

Auzias P, Delarue R, Strouk G, Guerre E, Limousin M, Fontaine C, Aumar A

机构信息

Service d'orthopédie, hôpital Roger-Salengro, CHRU de Lille, rue du Professeur Emile-Laine, 59037 Lille cedex, France.

Service d'orthopédie, hôpital Roger-Salengro, CHRU de Lille, rue du Professeur Emile-Laine, 59037 Lille cedex, France.

出版信息

Hand Surg Rehabil. 2019 Apr;38(2):114-120. doi: 10.1016/j.hansur.2019.01.004. Epub 2019 Jan 30.

Abstract

Several techniques have been described for fusion of the distal interphalangeal joint. The intramedullary Lync implant (Novastep™) may be superior to other options as it is available in straight or bent configurations, does not need to be removed and does not require fingertip incisions. The objective of our prospective study was to determine the effectiveness of finger distal interphalangeal (DIP) arthrodesis with Lync implants. Between February 2016 and June 2017, we performed 22 cases of DIP arthrodesis with this implant. Pain was assessed with a visual analog scale, the joint range of motion was measured using a digital goniometer, the pulp to palm distance was measured using a ruler, and the QuickDASH Questionnaire was filled out. AP and lateral X-rays were used to look for secondary displacement at 3 weeks and joint fusion at 6 weeks, 3 months, 6 months and 12 months. The primary endpoint was clinical and radiological union defined as the presence of trabecular bone bridges across the arthrodesis site. The patients' mean age was 57.8 years ± 9.9 (36-73). The mean follow up was 10 months ± 4.9 (3-15). The pre-operative pain level was 6/10 ± 2.4 (0-10) and it was 1.3/10 ± 1.7 (0-6) at 3 months post-operative (P < 0.0001). The mean pre-operative DASH Score was 64/100 ± 16 (15.9-86.3) and it was 19/100 ± 14 (2.3-45.4) at 3 months post-operative (P < 0.0001). At the end of the study, 20 DIP joints were fused (91%); 18 joints had fused at the 3 month follow-up visit (82%). Three cases required reoperation. DIP arthrodesis with the Lync implant resulted in DIP fusion in 91% of cases. When fusion was achieved, it provided pain relief and improved function. The Lync implant is less bulky than other arthrodesis devices and does not need to be removed.

摘要

已经描述了几种用于远侧指间关节融合的技术。髓内Lync植入物(Novastep™)可能优于其他选择,因为它有直形或弯形两种配置,无需取出,也不需要在指尖做切口。我们前瞻性研究的目的是确定使用Lync植入物进行手指远侧指间关节(DIP)融合术的有效性。在2016年2月至2017年6月期间,我们使用这种植入物进行了22例DIP融合术。使用视觉模拟量表评估疼痛,使用数字测角仪测量关节活动范围,使用尺子测量指腹到手掌的距离,并填写QuickDASH问卷。在术后3周拍摄正位和侧位X线片以观察是否有继发移位,在术后6周、3个月、6个月和12个月观察关节融合情况。主要终点是临床和影像学愈合,定义为在融合部位出现小梁骨桥。患者的平均年龄为57.8岁±9.9岁(36 - 73岁)。平均随访时间为10个月±4.9个月(3 - 15个月)。术前疼痛程度为6/10±2.4(0 - 10),术后3个月为1.3/10±1.7(0 - 6)(P < 0.0001)。术前平均DASH评分为64/100±16(15.9 - 86.3),术后3个月为19/100±14(2.3 - 45.4)(P < 0.0001)。在研究结束时,20个DIP关节融合(91%);在3个月的随访中,18个关节已融合(82%)。3例需要再次手术。使用Lync植入物进行DIP融合术在91%的病例中实现了DIP融合。当实现融合时,它缓解了疼痛并改善了功能。Lync植入物比其他融合装置体积更小,且无需取出。

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