Richter Martin
Abteilung für Hand- und Plastische Chirurgie, Helios-Klinikum Bonn/Rhein-Sieg, Von Hompesch-Str. 1, 53123, Bonn, Deutschland.
Oper Orthop Traumatol. 2021 Jun;33(3):216-227. doi: 10.1007/s00064-021-00711-0. Epub 2021 May 20.
To correct and prevent the proximalisation of the 1st ray by safe stabilisation using an autologous costochondral graft. Reduction of pain and maintaining good pinch and grip strength while preserving the important opposition of the thumb.
Painful proximalisation of the 1st ray after failed trapeziectomy with contact between the base of the 1st metacarpal and the trapezoid or scaphoid.
Painful conditions following trapeziectomy for other causes.
Perioperative antibiotic prophylaxis is required. Extension of the previous incision and exposure of the sensitive radial branches and the radial artery. Longitudinal incision of the capsule and excision of the scar from the trapezium cavity. Dissection of the scar tissue directly around the metacarpal 1 base. After longitudinal resection of the oblique trapezoid surface, insertion of a suture anchor into the scaphoid joint surface close to the trapezoid. Removal of an approximately 2 cm long piece of rib cartilage from the middle costal arch. Insertion of the costochondral graft into the trapezium space and fixation with the suture anchor. Stable capsule closure. Suction drain. Skin suture. Thumb-forearm splint.
Postoperative immobilisation of the carpometacarpal (CMC)-1 joint for 4 weeks in medium abduction position. In case of uneventful wound healing also with a well-fitting orthosis. Afterwards independent movement exercises and exercises in warm water. Hand therapy only in case of difficult mobilisation at the earliest 2 months after surgery.
From 2015-2018, 18 patients underwent surgery using this technique. The follow-up was at least 2 years after surgery. Of the 15 patients available for follow-up, 93% were classified as good and improved according to the Conolly-Rath score.
通过使用自体肋软骨移植进行安全固定来纠正和预防第1掌骨近端移位。减轻疼痛，保持良好的捏力和握力，同时保留拇指重要的对掌功能。
大多角骨切除术后失败，第1掌骨基部与大多角骨或舟骨之间存在接触导致第1掌骨近端疼痛性移位。
因其他原因导致的大多角骨切除术后疼痛情况。
需要围手术期预防性使用抗生素。延长先前的切口，暴露敏感的桡神经分支和桡动脉。纵向切开关节囊，切除大多角骨腔内的瘢痕。直接在第1掌骨基部周围解剖瘢痕组织。纵向切除斜形的大多角骨表面后，在靠近大多角骨的舟骨关节面插入缝线锚钉。从肋弓中部取下一段约2厘米长的肋软骨。将肋软骨移植片插入大多角骨间隙并用缝线锚钉固定。稳定地缝合关节囊。放置引流管。缝合皮肤。使用拇指-前臂夹板。
第1腕掌关节在中等外展位固定4周。如果伤口愈合顺利，也可使用合适的矫形器。之后进行自主运动锻炼和在温水中锻炼。仅在术后至少2个月难以活动时才进行手部治疗。
2015年至2018年，18例患者采用该技术进行手术。术后随访至少2年。在可进行随访的15例患者中，根据康诺利-拉特评分，93%被归类为良好或改善。
