热解碳 PIP 关节置换术的中期临床和影像学随访。

Midterm Clinical and Radiographic Follow-Up of Pyrolytic Carbon PIP Arthroplasty.

机构信息

Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.

出版信息

J Hand Surg Am. 2020 Mar;45(3):253.e1-253.e6. doi: 10.1016/j.jhsa.2019.06.008. Epub 2019 Aug 14.

DOI:10.1016/j.jhsa.2019.06.008

PMID:31420245

Abstract

PURPOSE

The use of pyrolytic carbon arthroplasty (PCA) for the proximal interphalangeal (PIP) joint is controversial. The goal of this study was to evaluate the clinical and radiographic midterm outcomes of PIP joint PCA.

METHODS

Patients were contacted after PIP PCA at 6.4 ± 1.9 years (mean ± SD). Evaluation included grip and pinch strength and digital range of motion (ROM). Radiographs and patient reported outcomes surveys were obtained.

RESULTS

This study included 29 PIP joint PCA devices implanted in 23 hands among 19 patients. Seven devices underwent subsequent procedures. Three were removed and revised to silicone implants because of 2 dislocations and one implant migration. One underwent revision to a larger distal component. Three required soft tissue surgical revisions in which the implant was retained (one flexor digitorum superficialis tenodesis and 2 capsulectomies). At the time of latest follow-up, there was 86.2% original implant survivorship. The most recent radiographic review of the remaining 26 implants revealed 2 swan neck deformities and 2 implant migrations. Postoperative grip (38.4 ± 16.8 lb) and pinch (13.8 ± 2.7 lb) strength were 92% and 91%, respectively, of nonsurgical grip and pinch strength. Final mean ROM (range) for the metacarpophalangeal joint was 82.1° (60° to 100°) and for the PIP joint was 60.6° (20° to 110°). Mean outcome scores were: visual analog scale, 1.6 (± 2.4), Michigan Hand Questionnaire, 71.6 (± 17.6), and Disabilities of the Arm, Shoulder, and Hand, 24.7 (± 14.5).

CONCLUSIONS

Midterm follow-up (mean, 6.4 years) for 29 PCA implants in 19 patients revealed a surgical revision rate of 24.1%. Of the 29 implants, 13.8% were removed at a mean of 4.6 years (range, 1.3-7.9 years). Strength, ROM, and pain relief were all satisfactory.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

摘要

目的

对于近指间关节（PIP），使用热解碳关节成形术（PCA）存在争议。本研究的目的是评估 PIP 关节 PCA 的临床和放射学中期结果。

方法

在 6.4±1.9 年（平均±标准差）后联系 PIP PCA 患者。评估包括握力和捏力以及手指活动度（ROM）。获得 X 线片和患者报告的结果调查。

结果

本研究包括 19 名患者的 23 只手中植入的 29 个 PIP 关节 PCA 装置。7 个装置进行了后续手术。由于 2 例脱位和 1 例假体迁移，3 个假体被取出并修改为硅胶假体。1 个假体修改为更大的远端组件。3 个需要软组织手术修订，保留假体（1 个屈指深肌肌腱转移术和 2 个关节囊切除术）。在最近一次随访时，原始假体存活率为 86.2%。对其余 26 个假体进行的最新放射学复查显示有 2 个天鹅颈畸形和 2 个假体迁移。术后握力（38.4±16.8 磅）和捏力（13.8±2.7 磅）分别为非手术握力和捏力的 92%和 91%。掌指关节的最终平均 ROM（范围）为 82.1°（60°至 100°），近指间关节为 60.6°（20°至 110°）。平均结果评分分别为：视觉模拟评分，1.6（±2.4），密歇根手问卷，71.6（±17.6），手臂、肩部和手残疾，24.7（±14.5）。