Selig Harald F, Schulz Matthias, Pillukat Thomas, Prommersberger Karl Josef, van Schoonhoven Jörg, Mühldorfer-Fodor Marion
Clinic for Hand Surgery, Rhön Medical Center, Campus Bad Neustadt, Von Guttenberg-Straße 11, 97616, Bad Neustadt/Saale, Germany.
Clinic for Plastic and Hand Surgery, HELIOS Klinikum Emil Von Behring GmbH, Berlin, Germany.
Arch Orthop Trauma Surg. 2020 Nov;140(11):1847-1857. doi: 10.1007/s00402-020-03592-3. Epub 2020 Sep 4.
The aim of this study was to compare the short-, mid-, and long-term results of pyrocarbon PIPJ arthroplasty.
Twenty-seven consecutive patients (9 males, 18 females) had arthroplasty for 32 pyrocarbon PIPJ prostheses. Two patients (two joints) were lost for follow-up. Four implants were removed during follow-up. Fifteen patients (18 implants) were available for a long-term follow-up assessment on average 9.7 (9-10.8) years postoperatively and seven patients with eight implants had telephone interviews to calculate the implant survival and complications. Of the 15 patients who came to the latest follow-up, 12 (14 implants) passed each of the three follow-up visits for short-term (ø 19 months), mid-term (ø 54 months), and long-term follow-up (ø 9.8 years) to compare functional and radiological parameters longitudinally.
In total, seven of the 30 joints (23%) required a revision surgery, all within the first 2 years postoperatively, including three arthrodesis due to early infection or dislocation, and one distal component removal due to primary loosening. Three patients required soft tissue revisions. The implant survival after 9 years was 87%. There was minimal pain at rest throughout the 9-year follow-up analysis; pain with activity was rated 1.9 at the short-term assessment, 1.5 at mid-term, and 1.6 at long-term. The average active range of motion was at short-, mid-, and long-term examination 49°, 50°, and 48° and grip strength averaged 24, 24, and 21 kg, respectively. The DASH score was stable with 35, 36, and 33 points. At the long-term follow-up, all evaluated implants showed radiological signs of implant loosening or migration. According to the PIP joint outcome score, 57% resulted finally in a "good" outcome.
Pyrocarbon PIPJ arthroplasty has a risk of early complications necessitating revision surgeries. In spite of radiological implant migration, good pain relief, grip strength, and high quality-of-life ratings are stable for a long time.
本研究的目的是比较热解碳掌指关节置换术的短期、中期和长期结果。
连续27例患者（9例男性，18例女性）接受了32个热解碳掌指关节假体的置换手术。2例患者（2个关节）失访。随访期间有4个植入物被取出。15例患者（18个植入物）平均在术后9.7（9 - 10.8）年接受了长期随访评估，7例有8个植入物的患者接受了电话访谈以计算植入物的生存率和并发症情况。在15例进行最新随访的患者中，12例（14个植入物）在短期（平均19个月）、中期（平均54个月）和长期随访（平均9.8年）的三次随访中均通过，以纵向比较功能和放射学参数。
30个关节中共有7个（23%）需要翻修手术，均在术后2年内，包括3例因早期感染或脱位而行关节融合术，1例因初次松动而行远端部件取出术。3例患者需要进行软组织翻修。9年后植入物生存率为87%。在9年的随访分析中，静息时疼痛轻微；活动时疼痛在短期评估中评分为1.9，中期为1.5，长期为1.6。短期、中期和长期检查时的平均主动活动范围分别为49°、50°和48°，握力平均分别为24、24和21千克。上肢功能障碍评分（DASH）稳定，分别为35、36和33分。在长期随访中，所有评估的植入物均显示出植入物松动或移位的放射学迹象。根据掌指关节结果评分，最终57%的结果为“良好”。
热解碳掌指关节置换术有早期并发症的风险，需要进行翻修手术。尽管植入物有放射学移位，但良好的疼痛缓解、握力和高生活质量评分在很长一段时间内是稳定的。
