Hand Surgery Unit, Ospedale S. Maria, Viale Tristano di Joannuccio, 05100 Terni TR, Italy.
Hand and Reconstructive Surgery Unit, Centro Traumatologico Ortopedico A. Alesini, via San Nemesio 21, 00145 Rome RM, Italy.
Hand Surg Rehabil. 2021 Apr;40(2):162-166. doi: 10.1016/j.hansur.2020.11.010. Epub 2021 Jan 27.
Excision of the trapezium is the common step in most arthroplasties for treating trapeziometacarpal arthritis. Trapeziectomy can be supplemented by several techniques intended to stabilize the first metacarpal but none of these has been proven superior. The aim of this study was to verify if a simplified suspension arthroplasty with the flexor carpi radialis (FCR) tendon, requiring only a single short surgical incision, no intraosseous tunnels and no interposition of prosthetic material, yields equal clinical outcomes to more complex techniques and if the clinical outcomes remain stable over the long term. A cohort of 299 patients was reviewed retrospectively at a follow-up ranging from 3 to 12 years (mean follow-up time 6 years) following total trapeziectomy and suspension arthroplasty using a half-tendon strip of FCR. At this long-term follow-up, the mean DASH score improved from 52 preoperatively to 20 postoperatively. Pain at follow-up was subjectively rated by patients as absent or improved in 92% cases. Thumb opposition assessed on the Kapandji scale was rated 9 or 10 in 144 (76%) hands, 7 or 8 in 30 (16%) hands and <7 in 15 hands (8%). Mean palmar flexion and radial abduction were 45° and 42°, respectively. Mean key pinch and grip strength were 4.7 Kg and 23.5 kg, respectively. When treating trapeziometacarpal osteoarthritis, surgical techniques that do not require complex procedures, bone tunnels, K wire stabilization or interposition of prosthetic materials can be considered and maybe preferred. Our technique of trapeziectomy and suspension arthroplasty with the FCR tendon produces good long-term results.
切除大多角骨是治疗大多角骨掌骨关节炎的大多数关节成形术中的常见步骤。大多角骨切除术可以辅以几种旨在稳定第一掌骨的技术，但没有一种技术被证明是优越的。本研究旨在验证使用屈肌支持带（FCR）肌腱的简化悬带关节成形术是否可以获得与更复杂技术相同的临床效果，并且如果临床效果是否长期稳定。回顾性分析了 299 例患者，随访时间为 3 至 12 年（平均随访时间 6 年），均接受了 FCR 半腱肌腱条的全大多角骨切除术和悬带关节成形术。在长期随访中，DASH 评分从术前的 52 分改善至术后的 20 分。92%的患者主观报告术后疼痛消失或改善。Kapandji 评分评估拇指对掌功能为 9 或 10 分的手有 144 只（76%），7 或 8 分的手有 30 只（16%），<7 分的手有 15 只（8%）。掌屈和桡偏的平均角度分别为 45°和 42°。平均捏力和握力分别为 4.7kg 和 23.5kg。在治疗大多角骨掌骨关节炎时，可以考虑使用不需要复杂手术、骨隧道、K 线固定或假体材料置入的手术技术，并且可能是首选技术。我们采用 FCR 肌腱进行大多角骨切除术和悬带关节成形术的技术可获得良好的长期效果。
