Jehan Shah, Javaid Iqbal Hafiz, Javaid Muhammad Mm, Mohammed Sharif Khalid
Acta Orthop Belg. 2020 Mar;86(1):137-145.
We performed a systematic review to find out the safety and efficacy of various procedures for isolated scaphotrapeziotrapezoid osteoarthritis. Eleven articles were included. The most common procedure was arthroplasty with pyrocarbon implant (28%), followed by resection of distal pole of scaphoid with proximal trapezium and trapezoid resection (18%). The other procedures included trapeziectomy with ligament reconstruction and tendon interposition (LRTI) (14%), arthroscopic resection of distal scaphoid (11%), trapezium and trapezoid resection with LRTI (10%) and arthrodesis (10%). Complications were noted in 18 (15%) patients. The most common complication (7.5%) was asymptomatic dorsal intercalated segmental instability (DISI) followed by dislocation of the pyrocarbon implant (3%). Fusion resulted in decreased range of motion and grip strength. The distal scaphoid resection was related to high rate of DISI. Although the pyrocarbon implant has a higher dislocation rate which requires revision surgery, this complication is avoidable with good surgical technique. Arthroplasty with pyrocarbon implant may be the first choice in younger patients.
我们进行了一项系统评价，以探究治疗孤立性舟大多角小多角骨关节炎的各种手术方法的安全性和有效性。共纳入11篇文章。最常见的手术方法是热解碳植入物关节成形术（28%），其次是舟骨远极切除联合近侧大多角骨和小多角骨切除（18%）。其他手术方法包括大多角骨切除联合韧带重建和肌腱嵌入术（LRTI）（14%）、关节镜下舟骨远极切除术（11%）、大多角骨和小多角骨切除联合LRTI（10%）以及关节融合术（10%）。18例（15%）患者出现并发症。最常见的并发症（7.5%）是无症状性背侧插入节段性不稳定（DISI），其次是热解碳植入物脱位（3%）。关节融合导致活动范围和握力下降。舟骨远极切除术与高发生率的DISI相关。尽管热解碳植入物脱位率较高，需要翻修手术，但通过良好的手术技术可避免这一并发症。热解碳植入物关节成形术可能是年轻患者的首选。
