Bäcker Henrik Constantin, Freibott Christina E, Rosenwasser Melvin Paul
Department of Orthopedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY 10032, United States.
World J Orthop. 2019 Aug 18;10(8):304-309. doi: 10.5312/wjo.v10.i8.304.
Basal joint arthritis is a common disease which is especially present in post-menopausal women. A variety of procedures have been described once conservative treatment has failed. The purpose of our study is to present a novel surgical technique based on a clinical case with three-year follow-up which is highly effective, even after failure of previous procedures.
We present a case of a 39 year-old-woman who suffered from recurring, persistent, sharp left thumb pain for several years After two operative procedures, she presented again with intolerable, sharp pain over the trapeziometacarpal joint, and wished to proceed with a pain relieving procedure or arthroplasty. Intraoperatively, the articular surfaces appeared well, without any bare areas of bone or eburnation, resulting in the decision to perform a "subtraction hemiarthroplasty". A shortening osteotomy of the os trapezium was performed by removing a slice of 8-9 mm bone, without damaging the joint cartilages. The osteotomy was stabilized using two screws, the ligament and capsular tissue was suture imbricated, and a cut down on the translation and a dorsal radial ligament reconstruction were performed. Three years after the final procedure, a long-term follow-up demonstrates excellent results, pain free with full range-of-motion.
Subtraction hemiarthroplasty with ligament tightening imbrication and reconstruction of the radial ligament led to excellent results in motion and pain.
拇指腕掌关节关节炎是一种常见疾病，尤其在绝经后女性中多见。一旦保守治疗失败，已有多种手术方法被描述。我们研究的目的是基于一例有三年随访的临床病例，介绍一种新的手术技术，即使在先前手术失败后，该技术仍非常有效。
我们报告一例39岁女性，她多年来一直遭受左拇指反复、持续、剧烈疼痛。经过两次手术后，她再次出现拇指腕掌关节难以忍受的剧痛，并希望进行缓解疼痛的手术或关节成形术。术中，关节面看起来良好，没有任何骨质裸露或骨质增生区域，因此决定进行“减法半关节成形术”。通过切除8 - 9毫米厚的一片骨头进行大多角骨缩短截骨术，未损伤关节软骨。用两枚螺钉固定截骨术，韧带和关节囊组织进行重叠缝合，并进行平移削减和桡背侧韧带重建。最后一次手术后三年的长期随访显示结果极佳，无痛且活动范围正常。
采用韧带收紧重叠缝合和桡侧韧带重建的减法半关节成形术在活动度和疼痛方面取得了极佳效果。
