Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, Nancy, France.
J Hand Surg Asian Pac Vol. 2021 Jun;26(2):158-165. doi: 10.1142/S2424835521500144.
The purpose of this retrospective study was to report and compare the outcomes of the MAIA prosthesis and trapeziectomy for trapeziometacarpal osteoarthritis. We included 92 consecutive patients (8 men, 84 women) with a mean age of 57 years (range 44-75 years) who underwent trapeziectomy (44 patients) or trapeziometacarpal joint replacement with a MAIA prosthesis (48 patients) for painful osteoarthritis. All patients were evaluated (pain, range of motion, strength, function, X-rays) by an independent examiner. The two groups of patients had comparable preoperative characteristics. At the mean follow-up of 9 years (range: 8-10), we found a significant reduction in pain levels for each group. In the final data review, there were no significant differences in terms of pain levels, grip strength, thumb active motion and the Quick Disabilities of the Arm, Shoulder and Hand score between the two groups. Pinch strength and the work performance score on the Michigan Hand Questionnaire were significantly better in the MAIA prosthesis group. The MAIA group had a shorter postoperative recovery time of 6 weeks and fewer patients required physiotherapy. Postoperatively, the thumb column length was significantly less in the trapeziectomy group. In this group, we found a significant decrease in the trapezial cavity height between the immediate postoperative evaluation and the final assessment, with three patients having painful scaphometacarpal impingement. Two patients required surgical revision for symptomatic meta-carpophalangeal joint hyperextension. In the MAIA group, we found no implant subsidence, loosening, dislocation or fracture. None of the implants were revised. From this study, we found that the both procedures can be used as a surgical treatment for trapeziometacarpal osteoarthritis. The MAIA prosthesis is a useful alternative to trapeziectomy and appears to be a reliable and effective implant in the medium- to long-term.
本回顾性研究旨在报告和比较 MAIA 假体与关节切除治疗腕掌关节骨关节炎的结果。我们纳入了 92 例连续患者（8 名男性，84 名女性），平均年龄 57 岁（范围 44-75 岁），他们因疼痛性骨关节炎接受了关节切除（44 例）或 MAIA 假体腕掌关节置换术（48 例）。所有患者均由独立检查者进行评估（疼痛、活动范围、力量、功能、X 射线）。两组患者术前特征具有可比性。在平均 9 年（范围：8-10 年）的随访中，我们发现两组患者的疼痛水平均显著降低。在最终数据分析中，两组间疼痛水平、握力、拇指主动运动和快速上肢手部功能障碍评分无显著差异。MAIA 假体组的捏力和密歇根手问卷的工作表现评分明显更好。MAIA 假体组术后恢复时间更短（6 周），需要物理治疗的患者更少。术后，关节切除组的拇指柱长度明显缩短。在该组中，我们发现术后即刻评估与最终评估之间的舟骨窝高度显著下降，有 3 例出现疼痛性舟状头状骨撞击。2 例因掌指关节过度伸展而出现症状性需要手术修复。在 MAIA 组中，我们未发现植入物下沉、松动、脱位或骨折。未对任何植入物进行修正。本研究表明，两种手术均可作为腕掌关节骨关节炎的治疗方法。MAIA 假体是关节切除的一种有效替代方法，在中至长期内是一种可靠有效的植入物。
