Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, UK.
Upper Limb Unit, Wrightington Hospital, Lancashire, UK.
J Hand Surg Am. 2024 May;49(5):489.e1-489.e7. doi: 10.1016/j.jhsa.2022.07.021. Epub 2022 Oct 25.
We describe a single-surgeon's experience of managing hand carpometacarpal joint (CMCJ) instability in elite boxers, focusing on injury characteristics, surgical technique, and outcomes.
This retrospective cohort included consecutive elite boxers undergoing surgery for hand CMCJ instability from 2009 to 2021. CMC joint instability is usually clear on clinical examination using a 'seesaw' test. All cases had a plain radiograph and in equivocal cases for instability advanced imaging such as MRI or ultrasound scan. CMCJs were accessed via longitudinal incisions between index/middle rays, and additionally ring/little. Often marked deficiency in the CMCJ ligamentous capsule was seen. The articular surfaces were decorticated to cancellous bone and autogenous bone graft impacted. The CMCJs were fixed in extension using various methods, latterly memory staples. Outcomes included radiographic fusion, return to boxing, and complications.
Forty hands had surgery in 38 boxers. In total, 101 CMCJs were fused, with an average of 2.5 joints per patient. Patients were mainly young (mean age 24.1 years), male (37/38) with the trailing hand more commonly affected (trailing hand 87.5%, leading hand 12.5%). The most frequently fused CMCJ was the index (97.5%, n = 39), then middle (95%, n = 38), ring (45%, n = 18), and little (15%, n = 6). There were 82% (31/38) of patients who returned to the same level of boxing at a median of 8 months from surgery (range 3-27 months). Three patients had revision surgery for non-union, a median of 10.3 months after initial surgery (range 9.4-133.1 months): 2 for index/middle and one for the little CMCJ. All 3 revisions fused and the patients returned to boxing at the same level, although the little CMCJ required a second bone graft and fixation.
Patients can achieve full recovery after treatment of CMCJ instability, and most can return to boxing at the same level with little risk of complications.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
我们描述了一位外科医生在管理精英拳击手中手舟月骨间关节（CMCJ）不稳定方面的经验，重点介绍了损伤特征、手术技术和结果。
这项回顾性队列研究纳入了 2009 年至 2021 年间因手部 CMCJ 不稳定接受手术治疗的连续精英拳击手。CMC 关节不稳定通常在使用“跷跷板”试验进行临床检查时很明显。所有病例均行常规 X 线检查，对于不稳定的情况，行 MRI 或超声等高级影像学检查。通过食指/中指射线之间的纵行切口以及环指/小指的附加切口来进入 CMCJ。通常可见 CMCJ 韧带囊明显缺陷。关节表面进行皮质骨化处理，并用自体骨移植填充。使用各种方法（后来使用记忆钉）将 CMCJ 固定在伸展位。结果包括影像学融合、重返拳击运动和并发症。
38 名拳击手中有 40 只手接受了手术。总共融合了 101 个 CMCJ，每个患者平均融合 2.5 个关节。患者主要为年轻男性（平均年龄 24.1 岁），惯用手（87.5%，38 例）更常受累，非惯用手（12.5%，38 例）。最常融合的 CMCJ 是食指（97.5%，39 例），其次是中指（95%，38 例）、环指（45%，18 例）和小指（15%，6 例）。有 82%（31/38）的患者在手术后中位数 8 个月（3-27 个月）时重返同一水平的拳击运动。有 3 例患者因非融合而接受了翻修手术，初次手术后中位数时间为 10.3 个月（9.4-133.1 个月）：2 例为食指/中指，1 例为小指 CMCJ。所有 3 例翻修均融合，患者重返同一水平的拳击运动，尽管小指 CMCJ 需要再次植骨和固定。
患者在治疗 CMCJ 不稳定后可以完全康复，大多数患者可以重返同一水平的拳击运动，且并发症风险很小。
研究类型/证据水平：治疗性 IV 级。
