类风湿关节炎患者硅胶植入关节成形术后掌指关节的体内运动学

In Vivo Metacarpophalangeal Joint Kinematics After Silicone Implant Arthroplasty in Patients With Rheumatoid Arthritis.

作者信息

Ishii Kazunori, Iwamoto Takuji, Oki Satoshi, Nagura Takeo, Matsumoto Morio, Nakamura Masaya

机构信息

Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.

出版信息

J Hand Surg Am. 2023 Jan;48(1):88.e1-88.e11. doi: 10.1016/j.jhsa.2021.10.001. Epub 2021 Nov 22.

DOI:10.1016/j.jhsa.2021.10.001

PMID:34823922

Abstract

PURPOSE

The aim of this study was to determine the potential mechanism of implant fracture using 3-dimensional motion analysis of patients with rheumatoid arthritis.

METHODS

Active flexion motion in 9 hands (34 fingers) of 6 female patients with rheumatoid arthritis who previously underwent hinged silicone metacarpophalangeal joint arthroplasty was examined using 4-dimensional computed tomography. Positions of the proximal phalanges relative to the metacarpals were quantified using a surface registration method. The deformation of the silicone implant was classified in the sagittal plane in the maximum flexion frame. The longitudinal bone axis of the proximal phalanx and the helical axis of the proximal phalanx were evaluated in 3-dimensional coordinates based on the hinge of the silicone implant.

RESULTS

Nineteen fingers were classified into group 1, in which the silicone implant moved volarly during flexion without buckling of the distal stem. Twelve fingers were classified into group 2, in which the distal stem of the silicone implant buckled. Three fingers were classified into group 3, in which the base of the distal stem had already fractured. Quantitatively, the longitudinal bone axes of the proximal phalanges were displaced from dorsal to volar in the middle stage of flexion and migrated in the proximal direction in the late phase of flexion. The helical axes of the proximal phalanges were located on the dorsal and proximal sides of the hinge, and these tended to move in the volar and proximal directions as the metacarpophalangeal joint flexed.

CONCLUSIONS

Volar and proximal translation of the proximal phalange was observed on 4-dimensional computed tomography.

CLINICAL RELEVANCE

Proximal displacement of the bone axis late in flexion appears to be a contributing factor inducing implant fractures, because the pistoning motion does not allow the implant to move in the proximal direction.

摘要

目的

本研究旨在通过对类风湿性关节炎患者进行三维运动分析，确定植入物骨折的潜在机制。

方法

使用四维计算机断层扫描检查6名先前接受过带铰链硅胶掌指关节置换术的类风湿性关节炎女性患者的9只手（34根手指）的主动屈曲运动。使用表面配准方法对近端指骨相对于掌骨的位置进行量化。在最大屈曲框架的矢状面内对硅胶植入物的变形进行分类。基于硅胶植入物的铰链，在三维坐标中评估近端指骨的纵向骨轴和近端指骨的螺旋轴。

结果

19根手指被归类为第1组，其中硅胶植入物在屈曲时向掌侧移动，远端柄未发生弯曲。12根手指被归类为第2组，其中硅胶植入物的远端柄发生弯曲。3根手指被归类为第3组，其中远端柄的基部已经骨折。定量分析显示，近端指骨的纵向骨轴在屈曲中期从背侧移位至掌侧，并在屈曲后期向近端迁移。近端指骨的螺旋轴位于铰链的背侧和近端，并且随着掌指关节的屈曲，这些轴倾向于向掌侧和近端移动。