Centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France.
Centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France.
Hand Surg Rehabil. 2021 Sep;40S:S62-S70. doi: 10.1016/j.hansur.2020.08.011. Epub 2021 Jan 14.
Many surgical options have been proposed for the treatment of first carpometacarpal (CMC1) osteoarthritis. Conventional techniques are invasive, so we wanted to develop an arthroscopic technique. Partial trapeziectomy combined with various interpositions and ligament reconstruction is a long-standing intervention. As in total trapeziectomy, the combination with ligament reconstruction remains controversial. The aim of this study was to demonstrate the benefits of adding an abductor pollicis longus (APL) ligament reconstruction to partial trapeziectomy performed under arthroscopy. This study analyzes the results of two consecutive case series carried out by a single surgeon. Thirty-four patients underwent an isolated partial trapeziectomy and 49 patients underwent partial trapeziectomy with ligament reconstruction using the APL. The patients were reviewed with an average follow-up of 3.7 years (13 months to 8.6 years) by an independent observer. The assessment included the analysis of pain, thumb appearance, QuickDASH score, Nelson Hospital score, and measurements of mobility and strength. For all patients, there was a marked reduction in pain (7.13 preoperatively vs.1.37 postoperatively) with 71% of patients having a painless thumb, the Nelson (11.14) and QuickDASH (17.89) scores as well as a clinical improvement in mobility and grip strength (14.5 KgF preop vs. 19.6 KgF postop) and key pinch (4.4 KgF preop vs. 5.4 KgF postop). The mean recovery time was 18.8 weeks. Eighty-four percent of patients were satisfied with the procedure with 90% having a stable thumb. No CRPS was found. However, the results were better for patients who underwent ligament reconstruction. There was a significant gain in grip strength, better first web opening and a lower percentage of painful thumbs. The other items were also slightly improved, but not significantly (Nelson Hospital score, QuickDASH score, key grip strength, percentage of stable thumbs, subjective thumb value estimated by patients). This technique is a less aggressive treatment of CMC1 osteoarthritis, with simplified and rapid rehabilitation. The addition of ligament reconstruction using the APL appears useful. The advantages of arthroscopy are a less painful postoperative course, low morbidity, ligament conservation, along with better access to remove loose bodies, osteophytes and to perform synovectomy. Partial trapeziectomy, which is especially indicated when the scaphotrapeziotrapezoid joint is not symptomatic, is much less used than total trapeziectomy; however, it is an attractive surgical option for young patients with significant functional demands. Arthroscopic partial trapeziectomy is a safe and reliable procedure.
许多手术选择已被提出用于治疗第一腕掌（CMC1）骨关节炎。传统技术具有侵入性，因此我们希望开发一种关节镜技术。部分腕掌切开术结合各种插入物和韧带重建术是一种长期的干预措施。与全腕掌切除术一样，结合韧带重建术仍存在争议。本研究的目的是证明在关节镜下进行部分腕掌切开术并同时进行拇长展肌（APL）韧带重建的益处。这项研究分析了由一位外科医生进行的两个连续病例系列的结果。 34 名患者接受了单纯的部分腕掌切开术，49 名患者接受了使用 APL 的部分腕掌切开术和韧带重建术。通过独立观察者平均随访 3.7 年（13 个月至 8.6 年）对患者进行了评估。评估包括疼痛、拇指外观、QuickDASH 评分、Nelson 医院评分以及活动度和力量测量。对于所有患者，疼痛明显减轻（术前 7.13 分，术后 1.37 分），71%的患者拇指无痛，Nelson（11.14）和 QuickDASH（17.89）评分以及活动度和握力（术前 14.5 KgF 与术后 19.6 KgF）以及关键捏力（术前 4.4 KgF 与术后 5.4 KgF）均有临床改善。平均恢复时间为 18.8 周。84%的患者对手术满意，90%的患者拇指稳定。未发现 CRPS。然而，接受韧带重建术的患者的结果更好。握力显著增加，第一掌指关节开口更好，疼痛拇指的百分比更低。其他项目也略有改善，但不显著（Nelson 医院评分、QuickDASH 评分、关键握力、稳定拇指的百分比、患者估计的拇指主观价值）。这种技术是治疗 CMC1 骨关节炎的一种侵袭性较小的方法，具有简化和快速康复的特点。使用 APL 进行韧带重建的效果更好。关节镜的优点是术后疼痛较轻，发病率低，韧带保持完整，同时可以更好地清除游离体、骨赘并进行滑膜切除术。当舟月骨间关节无症状时，特别适合进行部分腕掌切除术，其使用率远低于全腕掌切除术；然而，对于有明显功能需求的年轻患者来说，这是一种有吸引力的手术选择。关节镜下部分腕掌切除术是一种安全可靠的手术。
