Department of Orthopedic Surgery, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea.
Biomed Res Int. 2019 Jul 22;2019:7961507. doi: 10.1155/2019/7961507. eCollection 2019.
Trapeziometacarpal (TMC) arthritis is treated with surgery when nonsurgical treatment fails. The best surgical option for improving pain relief, functional outcomes, and postoperative complications remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between trapezium excision with ligament reconstruction and tendon interposition (LRTI) and pyrolytic carbon interpositional arthroplasty.
From March 2009 to August 2014, 37 patients (39 wrists) with Eaton-Littler stage II or III TMC arthritis underwent complete trapezium excision with LRTI (Group L, n=19) or pyrolytic interpositional arthroplasty (Group P, n=20). Visual analog scale (VAS) pain scores; grip and pinch strength; Kapandji scores to quantify thumb opposition; and Disabilities of Arm, Shoulder, and Hand (DASH) scores were used to compare clinical outcomes between the two groups. Radiographic changes (metacarpal shortening, subluxation, and radiolucency) were evaluated on the radiographs of thumb basal joints.
There were no differences in patient demographics, Eaton-Littler stage, preoperative outcome measures, or the duration of follow-up between the two groups. At the last follow-up, VAS pain scores, pinch and grip strengths, Kapandji scores, and DASH scores were significantly improved in both groups compared with preoperative scores. All follow-up measurements were similar between the two groups except pinch strength, which was 1.8 kg higher in Group P (p<0.001). Proximal metacarpal migration did not differ significantly between the groups. Periprosthetic lucency more than 1 mm was observed in 7 of 20 (35%) thumbs. Complication rates were similar between the two groups.
All subjective and objective outcomes were similar following LRTI and pyrolytic interpositional arthroplasty in patients with TMC arthritis, except pinch strength, which was more improved following pyrolytic interpositional arthroplasty. Longer follow-up is required to test adverse effects of high rates of periprosthetic lucency and prosthetic subluxation on clinical outcomes after PyroDisk interpositional arthroplasty.
当非手术治疗失败时，Trapeziometacarpal（TMC）关节炎采用手术治疗。改善疼痛缓解、功能结果和术后并发症的最佳手术选择仍存在争议。本研究的目的是比较 trapezium 切除伴韧带重建和肌腱间置（LRTI）与热解碳间置关节成形术的临床和影像学结果及并发症。
2009 年 3 月至 2014 年 8 月，37 例（39 腕）Eaton-Littler Ⅱ期或Ⅲ期 TMC 关节炎患者接受了完全 trapezium 切除伴 LRTI（L 组，n=19）或热解碳间置关节成形术（P 组，n=20）。视觉模拟量表（VAS）疼痛评分；握力和捏力；Kapandji 评分量化拇指对掌；和上肢残疾问卷（DASH）评分用于比较两组之间的临床结果。在拇指基底关节的 X 线片上评估放射影像学变化（掌骨缩短、半脱位和放射透光性）。
两组患者的人口统计学、Eaton-Littler 分期、术前结果测量和随访时间均无差异。末次随访时，两组患者 VAS 疼痛评分、捏力和握力、Kapandji 评分和 DASH 评分均较术前明显改善。除捏力外，两组的所有随访测量值均相似，P 组捏力高 1.8kg（p<0.001）。两组掌骨近端迁移无显著差异。20 个拇指中有 7 个（35%）出现超过 1mm 的假体周围透亮区。两组并发症发生率相似。
在 TMC 关节炎患者中，LRTI 和热解碳间置关节成形术后的所有主观和客观结果均相似，除了热解碳间置关节成形术后捏力改善更明显。需要更长时间的随访来测试假体周围透光率和假体半脱位的高发率对 PyroDisk 间置关节成形术后临床结果的不良影响。
