Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Japan.
Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan.
Arch Orthop Trauma Surg. 2021 Jul;141(7):1261-1268. doi: 10.1007/s00402-021-03838-8. Epub 2021 Mar 1.
Trapeziometacarpal osteoarthritis sometimes results in hyperextension of the thumb metacarpophalangeal (MCP) joint, which could negatively impact outcomes following trapeziectomy with ligament reconstruction and tendon interposition (LRTI) arthroplasty. Although algorithms on performing trapeziectomy with LRTI for the management of this deformity are available, they lack clear evidence. Here, we investigate the function of the thumb MCP joint after trapeziectomy with LTRI and whether this procedure alone corrects preoperative MCP hyperextension, and also analyze clinical factors correlated with MCP hyperextension post-surgery.
Twenty-eight patients who underwent trapeziectomy with LRTI and followed up for at ≥ 1 year (mean, 27.2 months) were retrospectively analyzed. No patient had concomitant surgery to the thumb MCP joint at the time of trapeziectomy with LRTI. Patients were divided into the < 30° (n = 19) and > 30° (n = 9) hyperextension groups as per their preoperative passive range of motion (ROM) of the MCP joint. Changes in ROM of the MCP joint post-surgery, clinical factors correlated with postoperative MCP hyperextension, and correlations between clinical outcomes and postoperative MCP extension were analyzed.
In the < 30° MCP hyperextension group, active and passive extensions of the MCP joint did not significantly change after surgery, and no worsening of postoperative MCP hyperextension was observed. In the > 30° hyperextension group, passive extension of the MCP joint significantly decreased (mean, 49.6°-29.8°). Preoperative MCP hyperextension improved in seven patients, was unchanged in 1, and worsened in 1. Postoperative passive MCP extension was negatively correlated with active/passive radial abduction, MCP flexion, trapezial space height, subjective outcomes, and hand strength post-surgery.
Trapeziectomy with LRTI alone could prevent postoperative thumb MCP hyperextension deformity for patients with thumb MCP extension < 30° and improve preoperative thumb MCP hyperextension. However, for patients with loss of radial abduction and MCP flexion due to the contracture, indirect correction of the MCP hyperextension was improbable.
掌腕关节骨关节炎有时会导致拇指掌指关节（MCP）过度伸展，这可能会对韧带重建和肌腱间置（LRTI）关节成形术治疗后的结果产生负面影响。虽然有关于掌骨切除术加 LRTI 治疗这种畸形的算法，但缺乏明确的证据。在这里，我们研究了 LTRI 手术后拇指 MCP 关节的功能，以及该手术是否单独纠正术前 MCP 过度伸展，并分析了与术后 MCP 过度伸展相关的临床因素。
回顾性分析了 28 例接受 LRTI 治疗并随访至少 1 年（平均 27.2 个月）的患者。在接受 LRTI 治疗的同时，没有患者接受拇指 MCP 关节的联合手术。根据术前 MCP 关节被动活动范围（ROM），患者分为<30°（n=19）和>30°（n=9）过度伸展组。分析了术后 MCP 关节 ROM 的变化、与术后 MCP 过度伸展相关的临床因素，以及临床结果与术后 MCP 伸展之间的相关性。
在<30°MCP 过度伸展组，术后 MCP 关节的主动和被动伸展均无明显变化，且未观察到术后 MCP 过度伸展的恶化。在>30°过度伸展组，MCP 关节的被动伸展明显减少（平均 49.6°-29.8°）。7 例患者的术前 MCP 过度伸展改善，1 例不变，1 例恶化。术后被动 MCP 伸展与主动/被动桡偏、MCP 屈曲、掌骨间空间高度、主观结果和术后手部力量呈负相关。
LRTI 单独治疗掌骨切除术可预防拇指 MCP 伸展<30°的患者术后拇指 MCP 过度伸展畸形，并改善术前拇指 MCP 过度伸展。然而，对于因挛缩而丧失桡偏和 MCP 屈曲的患者，MCP 过度伸展的间接矫正不太可能。
