Herren Daniel B, Fuchs Nina, Schindele Stephan, Marks Miriam
Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland.
Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland *Both authors equally contributed to this paper.
J Hand Surg Eur Vol. 2021 Dec;46(10):1101-1107. doi: 10.1177/17531934211050559. Epub 2021 Oct 20.
This study investigated revision surgery for the thumb after failed trapeziectomy with ligament reconstruction and tendon interposition and defined a revision concept. Twenty-four patients with 25 affected thumbs were examined at a mean of 5.5 years after their last revision operation. Pain during daily activities was 2.7 on a 0-10 numeric rating scale, pain at rest was 1.6 and the brief Michigan Hand Outcomes Questionnaire score was 63. Although 68% of patients indicated that their thumb was better than before primary surgery, the outcome after revision surgery was less favourable than that reported for primary trapeziectomy with ligament reconstruction and tendon interposition. We defined a revision algorithm to use as a guide for patients with residual symptoms after resection arthroplasty. The main reason for revision, symptomatic impingement of the thumb metacarpal, should be treated with resection of the metacarpal base and scaphotrapezoidal joint. An existing interposition should be revised, or a new interposition should be used, preferably with an autologous tendon or alternately with an allograft. IV.
本研究对韧带重建和肌腱植入的大多角骨切除术后拇指翻修手术进行了调查，并确定了翻修概念。对24例患25侧拇指的患者进行了检查，平均时间为上次翻修手术后5.5年。日常活动时的疼痛在0至10数字评分量表上为2.7，静息时疼痛为1.6，简短的密歇根手部结果问卷评分为63。虽然68%的患者表示其拇指比初次手术前有所改善，但翻修手术后的结果不如初次大多角骨切除联合韧带重建和肌腱植入所报告的结果。我们定义了一种翻修算法，用作切除关节成形术后有残余症状患者的指导。翻修的主要原因，即拇指掌骨的症状性撞击，应通过掌骨基部和舟大多角关节切除术来治疗。应翻修现有的植入物，或使用新的植入物，最好使用自体肌腱，也可使用同种异体移植物。四、
