From the Department of Orthopaedic Surgery, Duke University Medical Center.
Plast Reconstr Surg. 2022 Sep 1;150(3):601-605. doi: 10.1097/PRS.0000000000009408. Epub 2022 Jul 1.
Several surgical procedures have been described to treat thumb carpometacarpal osteoarthritis, including suture button suspensionplasty and ligament reconstruction and tendon interposition. To date, no single procedure has demonstrated clinical superiority. Suture button suspensionplasty has achieved favorable outcomes at 5 years in primary cases, but has not been validated in revision surgery. In this study, it was evaluated for revision of failed thumb carpometacarpal osteoarthritis surgery, and outcomes were compared to ligament reconstruction and tendon interposition outcomes. A retrospective chart review identified patients who underwent suture button suspensionplasty or ligament reconstruction and tendon interposition after failure of previous thumb carpometacarpal osteoarthritis surgery since 2010. Eighteen patients were included, with nine patients in each group. Eighteen patients had mean final follow-up of 35 months. There were two complications in the ligament reconstruction and tendon interposition group and none in the suture button suspensionplasty group. No patients required additional surgery. The suture button suspensionplasty group had an average visual analogue scale pain score improvement of 2.9, compared to 2.4 in the ligament reconstruction and tendon interposition group. Average final Quick Disabilities of the Arms, Shoulder and Hand questionnaire score was 15.1 in the suture button suspensionplasty group, compared to 22.6 in the ligament reconstruction and tendon interposition group. Mean operative time of 86.3 minutes in the suture button suspensionplasty group was significantly shorter than the 121-minute mean in the ligament reconstruction and tendon interposition group. Suture button suspensionplasty is an effective treatment option for revision of previous thumb carpometacarpal osteoarthritis surgery, with outcomes comparable to revision using ligament reconstruction and tendon interposition, and the added benefit of shorter operative times and early mobilization.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
几种手术方法已被用于治疗拇指腕掌关节炎，包括缝线纽扣悬吊成形术和韧带重建及肌腱嵌入术。迄今为止，尚无单一手术方法显示出临床优势。缝线纽扣悬吊成形术在原发性病例的 5 年随访中取得了良好的效果，但尚未在翻修手术中得到验证。在这项研究中，它被评估用于治疗失败的拇指腕掌关节炎手术的翻修，并且将结果与韧带重建和肌腱嵌入术的结果进行比较。回顾性图表审查确定了自 2010 年以来因先前拇指腕掌关节炎手术失败而接受缝线纽扣悬吊成形术或韧带重建和肌腱嵌入术的患者。共纳入 18 例患者，每组 9 例。18 例患者的平均最终随访时间为 35 个月。韧带重建和肌腱嵌入组有 2 例并发症，缝线纽扣悬吊成形术组无并发症。没有患者需要进一步手术。缝线纽扣悬吊成形术组的视觉模拟评分疼痛改善平均值为 2.9，而韧带重建和肌腱嵌入术组为 2.4。缝线纽扣悬吊成形术组的最终快速上肢残疾问卷评分平均为 15.1，而韧带重建和肌腱嵌入术组为 22.6。缝线纽扣悬吊成形术组的平均手术时间为 86.3 分钟，明显短于韧带重建和肌腱嵌入术组的 121 分钟。缝线纽扣悬吊成形术是治疗先前拇指腕掌关节炎手术翻修的有效方法，其结果与使用韧带重建和肌腱嵌入术相当，并且具有手术时间更短和早期活动的额外优势。
临床问题/证据水平：治疗性，III 级。
