Pôle Urgences Main Nice, 10, Boulevard Pasteur, 06000 Nice, France.
Hand Surg Rehabil. 2021 Sep;40S:S77-S82. doi: 10.1016/j.hansur.2020.05.017. Epub 2021 Jan 20.
Our aim was to explore the different indications of the Mini TightRope® suture button whether during first-line treatment or secondary surgery of thumb carpometacarpal osteoarthritis (OA). The indications for this new device are presented and discussed based on our own small case series and published data. Twenty-one patients treated with the Mini TightRope® were included in a prospective study. One of them was operated on both sides. Fourteen devices were used in first intention for Eaton stage IV OA; the patients underwent trapeziectomy and suture button suspensioplasty only. Four cases consisted of revision surgery for painful proximalization of the first metacarpal after trapeziectomy and ligamentoplasty. Four cases consisted of secondary surgery after trapeziectomy and implant interposition (two silicone implants and two pyrocarbon implants). We captured the demographic data, follow-up time, pain level, pinch strength before and after surgery, range of motion, metacarpal subsidence, and postoperative complications. The average age of the patients was 60 years. There were 19 women and 2 men. The average follow-up time was 2.5 years (1-4). The average pain level, according to a visual analog scale (1-10) was 3.5 (2-5) preoperatively and 2 (1-4) postoperatively at rest and 7 (6-8) preoperatively and 4 (3-6) postoperatively with maximum load. The mean Kapandji score was 9 (7-10) and the retropulsion score was 3 (1-4). The average key pinch and tip pinch strengths were 80% and 78% of the contralateral side at the final follow-up. The trapeziectomy-suspensioplasty group had greater average trapezial space height compared to the revision surgery group (7.0 mm vs. 4.5 mm). There are several indications for the Mini TightRope® device in the treatment of severe thumb carpometacarpal OA: first metacarpal suspension during open or arthroscopic total or partial trapeziectomy and secondary surgery after failure of trapeziectomy with or without implant interposition. The advantage of this new device, which suspends the first metacarpal off the second metacarpal, is the very short immobilization period contrary to other suspensioplasty procedures.
我们的目的是探讨 Mini TightRope®缝线纽扣在拇腕掌关节炎（OA）一线治疗或二次手术中的不同适应证。基于我们自己的小系列病例和已发表的数据，介绍并讨论了这种新装置的适应证。21 例接受 Mini TightRope®治疗的患者纳入前瞻性研究。其中 1 例双侧手术。14 例设备用于 Eaton Ⅳ期 OA 的一线治疗；患者仅接受梯形切除术和缝线纽扣悬吊成形术。4 例为梯形切除和韧带成形术后第一掌骨近端化疼痛的翻修手术。4 例为梯形切除和植入物间置（2 例硅酮植入物和 2 例石墨植入物）后的二次手术。我们记录了患者的人口统计学数据、随访时间、疼痛程度、手术前后的捏力、活动范围、掌骨下沉和术后并发症。患者的平均年龄为 60 岁。其中 19 例为女性，2 例为男性。平均随访时间为 2.5 年（1-4 年）。根据视觉模拟评分（1-10），平均疼痛水平为术前 3.5（2-5）分，术后休息时 2 分（1-4）分；术前 7（6-8）分，术后最大负荷时 4（3-6）分。平均 Kapandji 评分为 9（7-10），反推评分 3（1-4）。末次随访时，平均关键捏力和指尖捏力分别为对侧的 80%和 78%。梯形切除术-悬吊成形术组的平均梯形空间高度大于翻修手术组（7.0mm 比 4.5mm）。Mini TightRope®装置在治疗严重拇指腕掌关节炎时有多种适应证：开放式或关节镜下全或部分梯形切除术时第一掌骨的悬吊，以及梯形切除术失败后伴或不伴植入物间置的二次手术。这种新装置将第一掌骨悬吊在第二掌骨上，与其他悬吊成形术相比，其优点是固定时间非常短。
