University of Florida, Gainesville, USA.
Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Hand (N Y). 2022 Jan;17(1):85-91. doi: 10.1177/1558944720906565. Epub 2020 Feb 26.
Multiple surgical techniques are described for basal joint osteoarthritis. This study compares clinical outcomes and patient satisfaction with trapeziectomy and abductor pollicis longus (APL) suspensionplasty compared to trapeziectomy with ligament reconstruction and tendon interposition (LRTI) when performed by 2 fellowship-trained hand surgeons. A retrospective review of 51 consecutive patients undergoing APL suspensionplasty (53 hands) was performed. With this technique, a distally based APL slip is brought through and sewn to the flexor carpi radialis (FCR). The remaining APL is placed in the trapeziectomy void. This technique was compared to 151 patients (166 hands) who underwent LRTI using the FCR tendon. Outcomes assessed included postoperative pain relief, grip and pinch strength, complications, and need for reoperation. Two-tailed, Fisher's exact test was used for data analysis. APL suspensionplasty resulted in postoperative pain relief in 92.5% (n = 49) compared to 94.0% (n = 156) with LRTI ( = .758). Mean postoperative grip and pinch strengths with APL suspensionplasty were 41.2 and 10.4 kg, respectively. With LRTI, average grip strength was 42.0 kg, and pinch was 10.1 kg. Both techniques were well tolerated with minimal complications. In the APL group, 1 patient had a postoperative infection requiring drainage. Among the LRTI cases, 1 wound dehiscence required closure, and 2 minor postoperative wound infections resolved with oral antibiotics. Mean follow-up time among APL suspensionplasty patients was 3.3 months compared to 8.4 months following LRTI. APL suspensionplasty is a safe, effective procedure which provides similar pain relief and functional outcomes compared to LRTI.
多种手术技术被用于治疗基底部关节骨关节炎。本研究比较了由 2 位手部 fellowship培训医师施行的掌骨基底切开术（trapeziectomy）联合拇长展肌（abductor pollicis longus，APL）悬吊术与韧带重建和肌腱间置术（ligament reconstruction and tendon interposition，LRTI）的临床结果和患者满意度。对 51 例连续接受 APL 悬吊术（53 只手）的患者进行了回顾性研究。该技术将远侧基底部 APL 滑动通过并缝合到屈肌支持带（flexor carpi radialis，FCR）。剩余的 APL 放置在掌骨基底切除的骨槽内。将该技术与使用 FCR 肌腱的 151 例患者（166 只手）的 LRTI 进行了比较。评估的结果包括术后疼痛缓解、握力和捏力、并发症和再次手术的需要。使用双侧 Fisher 确切检验进行数据分析。APL 悬吊术后 92.5%（n=49）的患者疼痛缓解，而 LRTI 为 94.0%（n=156）（ =.758）。APL 悬吊术后平均握力和捏力分别为 41.2kg 和 10.4kg。LRTI 的平均握力为 42.0kg，捏力为 10.1kg。两种技术的耐受性均良好，并发症较少。在 APL 组中，1 例患者发生术后感染，需要引流。在 LRTI 组中，1 例伤口裂开，2 例轻微术后伤口感染经口服抗生素治愈。APL 悬吊术后患者的平均随访时间为 3.3 个月，而 LRTI 为 8.4 个月。APL 悬吊术是一种安全有效的手术，与 LRTI 相比，可提供相似的疼痛缓解和功能结果。
