Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique et assistance Main CHU Jean Minjoz, Boulevard Fleming, 25000 Besançon, France.
Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique et assistance Main CHU Jean Minjoz, Boulevard Fleming, 25000 Besançon, France.
Hand Surg Rehabil. 2021 Jun;40(3):211-223. doi: 10.1016/j.hansur.2020.12.007. Epub 2021 Feb 22.
Scaphotrapeziotrapezoid osteoarthritis (STT OA) is common and often associated with thumb basal joint arthritis. Pain at the base of the thumb on the volar aspect and during resisted extension is characteristic of symptomatic STT OA. If conservative treatment fails, surgical treatment may be offered. In case of STT OA, treatment may range from arthrodesis to trapeziectomy (isolated or associated with ligament reconstruction and/or interposition). Any preoperative intracarpal instability (DISI) can be exacerbated by resecting more than 3 or 4 mm of the distal pole of scaphoid. For peritrapezial osteoarthritis, trapeziectomy is the logical solution, but it exposes the patient to known complications: loss of strength, long recovery, trapeziometacarpal impingement. Initial treatment of thumb basal joint arthritis by arthroplasty is also an option. Treatment of both sites is also possible by interposition of pyrocarbon implants. In all cases (isolated or associated STT OA) and no matter the technique chosen, maintaining the scaphoid height (arthrodesis, resection < 3 mm and/or associated interposition) and performing oblique trapezoidal osteotomy (to prevent scaphoid-metacarpal impingement) are the two crucial elements of surgical treatment.
舟月骨间关节炎（STT OA）较为常见，常与拇指基底部关节炎相关。拇指基底部掌侧疼痛和抵抗伸展时疼痛是有症状的 STT OA 的特征。如果保守治疗失败，可能会提供手术治疗。在 STT OA 的情况下，治疗方法的范围可能从融合到切除（单独或与韧带重建和/或间置）。如果切除超过 3 或 4 毫米的舟骨远端，任何术前腕骨间不稳定（DISI）都可能加重。对于周围性舟状骨关节炎，切除是合理的解决方案，但它会使患者面临已知的并发症：力量丧失，恢复时间长，舟状骨和大多角骨撞击。拇指基底部关节炎的初始关节成形术治疗也是一种选择。通过植入聚碳酸酯植入物也可以同时治疗两个部位。在所有情况下（单独或相关的 STT OA），无论选择何种技术，维持舟骨高度（融合、切除<3 毫米和/或相关的间置）和进行斜梯形截骨术（以防止舟骨和大多角骨撞击）是手术治疗的两个关键要素。
