Muramatsu Keiichi, Tominaga Yasuhiro, Hashimoto Takahiro, Taguchi Toshihiko
1 Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Yamaguchi, Japan.
J Hand Surg Asian Pac Vol. 2019 Mar;24(1):55-59. doi: 10.1142/S2424835519500103.
The trapeziometacarpal joint is the second most common site of osteoarthritis in the hand and the most frequent one to require surgery. Arthrodesis of the trapeziometacarpal joint is recognized as one of the valuable technique but unfortunately there has been wide variation in the union rate. The purpose of this study was to evaluate a new arthrodesis technique involving a cross-shaped bone graft and locking plate fixation.
Eleven male patients diagnosed as Eaton's stage III osteoarthritis of the trapeziometacarpal join were treated in our institute. The mean patient age was 62 years (range 50 to 80 years). At the day after surgery, physical therapy was started and free use of the hand was permitted.
Patients showed radiographic evidence of trapeziometacarpal joint union after an average postoperative period of 8.3 weeks (range 6-12 weeks). The VAS pain score significantly decreased from 7.2 points preoperatively to 0.4 points after surgery. Mean side pinch strength increased significantly from 3.8 kg (53% compared to unaffected side) prior to surgery to 6.2 kg (86%). The DASH score improved from 38.6 (range 34.1-43.2) preoperatively to 17.0 (6.8-22.7) postoperatively.
These data suggested that our technique is a successful procedure for the trapeziometacarpal joint arthrodesis. Cross-shaped bone grafts have the advantages of restoring thumb length and providing internal stabilization, especially for rotational force. No complications arose at the bone harvest site of the iliac crest. The procedure seems to be technically demanding, particularly for adapting the bone graft to perfectly match the shape of the defect.
大多角骨-第一掌骨间关节是手部骨关节炎的第二常见发病部位，也是最常需要手术治疗的部位。大多角骨-第一掌骨间关节融合术被认为是一种有效的技术，但遗憾的是，其愈合率差异很大。本研究的目的是评估一种采用十字形植骨和锁定钢板固定的新型融合技术。
11例被诊断为Eaton III期大多角骨-第一掌骨间关节骨关节炎的男性患者在我院接受治疗。患者平均年龄为62岁（范围50至80岁）。术后第一天开始物理治疗，并允许手部自由活动。
术后平均8.3周（范围6 - 12周），患者的影像学检查显示大多角骨-第一掌骨间关节融合。视觉模拟评分（VAS）疼痛评分从术前的7.2分显著降至术后的0.4分。平均侧捏力从术前的3.8千克（占未受影响侧的53%）显著增加至6.2千克（占86%）。上肢功能障碍评分（DASH）从术前的38.6（范围34.1 - 43.2）改善至术后的17.0（6.8 - 22.7）。
这些数据表明我们的技术是一种成功的大多角骨-第一掌骨间关节融合术。十字形植骨具有恢复拇指长度和提供内固定的优点，特别是对于旋转力。髂嵴取骨部位未出现并发症。该手术在技术上似乎要求较高，特别是在使植骨完美匹配缺损形状方面。
