Ledoux Pascal
Clinique du Parc, 48 bis, rue Henri Barbusse, 59880 Saint-Saulve, France.
Hand Surg Rehabil. 2021 Sep;40S:S143-S150. doi: 10.1016/j.hansur.2020.08.010. Epub 2021 Jan 13.
Surgical treatment of thumb basal joint arthritis generally yields good and excellent results. In case of failure, the surgeon will propose an appropriate solution to the patient, one that can be performed easily. Each technique has its own complications: shortening with trapeziometacarpal pain following trapeziectomy, loosening and instability following total arthroplasty, instability for some implants. There are also intolerances such as allergies to nickel, foreign body reactions to silicone and inflammatory reactions to some synthetic ligament implants. It is important to bear these complications in mind when determining the best possible surgical technique initially. The different surgical solutions are exposed here. Prosthetic replacement is preferred in case of loosening when it is technically possible in order to preserve the thumb's length. A conversion to trapeziectomy with or without interposition (implant or ligament reconstruction) will be carried out in the other cases. In case of trapeziectomy failure, solutions are more difficult to find. In the current state of things, it seems that implant or biological tissue interposition is the best solution.
拇指腕掌关节关节炎的手术治疗通常能取得良好及优异的效果。若手术失败，外科医生会向患者提出一种易于实施的合适解决方案。每种技术都有其自身的并发症：大多角骨切除术后会出现缩短并伴有大多角掌骨疼痛，全关节置换术后会出现松动和不稳定，某些植入物会出现不稳定。也存在一些不耐受情况，如对镍过敏、对硅胶的异物反应以及对某些合成韧带植入物的炎症反应。在最初确定最佳手术技术时，牢记这些并发症很重要。这里介绍了不同的手术解决方案。在技术可行的情况下，若出现松动，假体置换是首选，以保留拇指长度。在其他情况下，将进行伴或不伴间置（植入物或韧带重建）的大多角骨切除术。若大多角骨切除术失败，解决方案则更难找到。就目前的情况而言，植入物或生物组织间置似乎是最佳解决方案。
