Rothman Institute of Thomas Jefferson University, Philadelphia, PA, USA.
Hand (N Y). 2023 Jan;18(1):98-104. doi: 10.1177/1558944721994227. Epub 2021 Mar 31.
Thumb carpometacarpal (CMC) joint arthroplasty is a common procedure in the surgical management of symptomatic thumb basal joint arthritis. Following trapeziectomy, a number of suspensionplasty techniques are often used, but limited comparative evidence exists between these techniques. The central aim of this study was to prospectively compare the outcomes of 2 suspensionplasty techniques following trapeziectomy: suture button (TightRope) versus ligament reconstruction and tendon interposition (LRTI).
Prospective data were collected on 112 consecutive patients with Eaton stage III-IV thumb CMC arthritis who underwent open trapeziectomy and suspensionplasty. There were 53 LRTI and 59 TightRope suspensionplasty procedures. Outcomes were measured using the Quick Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, Visual Analogue Scale (VAS) for pain, radiographic analysis, and lateral pinch strength. Patient demographic data and complications were also recorded.
Patients undergoing TightRope suspensionplasty had significantly higher trapeziometacarpal index and thus less subsidence than the LRTI group at 2 weeks (0.22 vs 0.17 [0001]) and 3 months (0.17 vs 0.15 [ .05]) postoperatively. TightRope suspensionplasty also had a significantly lower DASH score at 2 weeks (64.7 vs 74.6 [ .05]), 3 months (20.7 vs 32.5 [ < .05]), and 1 year postoperatively (7.57 vs 21.5 [ < .05]) compared with the LRTI group. However, there was no difference in VAS pain, lateral pinch strength, reoperation, or complications at any time point between groups.
Thumb CMC joint arthroplasty performed with a TightRope suspensionplasty versus LRTI yielded short-term improved resistance to subsidence, long-term greater improvement in clinical outcome by DASH, and no difference in pain or complication rates.
拇指腕掌（CMC）关节关节炎是治疗症状性拇指基底部关节炎的常见手术方法。在施行腕掌切开术（trapeziectomy）后，通常会采用多种悬吊成形术（suspensionplasty）技术，但这些技术之间的比较证据有限。本研究的主要目的是前瞻性比较两种腕掌切开术后悬吊成形术技术的结果：缝线纽扣（TightRope）与韧带重建和肌腱转移（LRTI）。
连续收集了 112 例 Eaton Ⅲ-Ⅳ期拇指 CMC 关节炎患者的前瞻性数据，这些患者均接受了开放性腕掌切开术和悬吊成形术。其中 53 例行 LRTI 手术，59 例行 TightRope 悬吊成形术。使用快速残疾上肢、肩和手（Quick Disabilities of the Arm, Shoulder, and Hand，DASH）问卷、疼痛视觉模拟量表（Visual Analogue Scale，VAS）、影像学分析和侧捏力来测量结果。还记录了患者的人口统计学数据和并发症。
TightRope 悬吊成形术组的掌骨间角指数（trapeziometacarpal index）明显高于 LRTI 组，因此术后 2 周（0.22 比 0.17[0.01]）和 3 个月（0.17 比 0.15[.05]）时的沉降程度较低。与 LRTI 组相比，TightRope 悬吊成形术组术后 2 周（64.7 比 74.6[.05]）、3 个月（20.7 比 32.5[<.05]）和 1 年时（7.57 比 21.5[<.05]）的 DASH 评分明显较低。然而，两组在任何时间点的 VAS 疼痛、侧捏力、再次手术或并发症方面均无差异。
与 LRTI 相比，采用 TightRope 悬吊成形术治疗拇指 CMC 关节关节炎可短期提高抗沉降能力，长期通过 DASH 改善临床疗效，且疼痛或并发症发生率无差异。
