Service de chirurgie orthopédique et traumatologique, hôpital de la Cavale Blanche, boulevard Tanguy-Prigent, 29200 Brest, France.
Service de chirurgie orthopédique et traumatologique, centre hospitalier De Cornouaille, avenue Yves-Thépot, 29107 Quimper, France.
Orthop Traumatol Surg Res. 2024 Apr;110(2):103366. doi: 10.1016/j.otsr.2022.103366. Epub 2022 Jul 15.
Trapezio-metacarpal osteoarthritis is a common condition for which the reference standard treatment after failure of non-operative measures is trapeziectomy. Several techniques have been devised to avoid proximal migration of the first metacarpal bone (M1) with impingement on the scaphoid bone. We have developed a Gore-Tex® ligament reconstruction technique that avoids potential complications of tendon harvesting. The objective of this study was to assess the long-term outcomes of this technique.
Trapeziectomy with Gore-Tex® ligament reconstruction is a reliable option for providing lasting pain relief in patients with trapezio-metacarpal osteoarthritis.
We conducted an observational, single-centre, single-surgeon, retrospective cohort study in consecutive patients managed by primary trapeziectomy. We excluded patients with revision trapeziectomy or less than 10 years' follow-up. The primary outcome was event-free survival, defined as absence of revision surgery and of a numerical rating scale score for pain above 3/10. The secondary criteria were clinical tolerance of the Gore-Tex® implant and radiological changes. The patients were assessed at last follow-up either in person or during a teleconsultation.
Of 78 included joints, 54 were assessed during patient visits and 24 by teleconsultation. At 10 years, the event-free survival rate was 91.3%, and 60.3% of patients were free of pain. Evidence of osteolysis was visible in 24% of patients. No patient experienced clinical intolerance of the Gore-Tex® implant. The mean Disabilities of Arm, Shoulder and Hand score was 25.5. Metacarpo-phalangeal hyperextension was significantly increased, to 30.6°, and the mean trapezial space ratio was significantly decreased, to 39.1% of the baseline value.
Long-term event-free survival was high. Functional outcomes and pain were similar to previous reports. Trapeziectomy with Gore-Tex® ligament reconstruction obviates the need for tendon harvesting. Osteolysis developed in some patients but did not correlate with clinical intolerance. Long-term clinical and radiological monitoring is in order after Gore-Tex® implantation.
IV, Observational, single-centre, single-surgeon, retrospective cohort study.
掌腕关节炎是一种常见疾病，对于非手术治疗失败的患者，参考标准治疗方法是腕骨切除术。已经设计了几种技术来避免第一掌骨（M1）近端迁移并与舟状骨发生撞击。我们开发了一种 Gore-Tex®韧带重建技术，可避免肌腱采集的潜在并发症。本研究的目的是评估该技术的长期结果。
腕骨切除术联合 Gore-Tex®韧带重建是治疗掌腕关节炎患者疼痛的可靠选择。
我们对连续接受初次腕骨切除术治疗的患者进行了一项观察性、单中心、单外科医生、回顾性队列研究。我们排除了接受翻修腕骨切除术或随访时间少于 10 年的患者。主要结果是无事件生存，定义为无翻修手术和疼痛数字评分量表评分超过 3/10。次要标准是对 Gore-Tex®植入物的临床耐受性和影像学变化。患者在最后一次随访时或通过远程会诊进行评估。
78 个关节中，54 个通过患者就诊进行评估，24 个通过远程会诊进行评估。10 年时，无事件生存率为 91.3%，60.3%的患者无疼痛。24%的患者可见骨溶解证据。无患者出现 Gore-Tex®植入物的临床不耐受。平均上肢残疾评分（DASH）为 25.5。掌指关节过伸明显增加，达到 30.6°，腕骨空间比明显降低，至基线值的 39.1%。
长期无事件生存率较高。功能结果和疼痛与先前的报告相似。腕骨切除术联合 Gore-Tex®韧带重建避免了肌腱采集的需要。一些患者出现骨溶解，但与临床不耐受无关。Gore-Tex®植入后需要进行长期的临床和影像学监测。
IV，观察性、单中心、单外科医生、回顾性队列研究。
