Meyers Abigail, Krebs Jillian P, Rampazzo Antonio, Bassiri Gharb Bahar
From the Department of Plastic Surgery, Cleveland Clinic.
Plast Reconstr Surg. 2023 Mar 1;151(3):432e-440e. doi: 10.1097/PRS.0000000000009921. Epub 2022 Nov 22.
An institutional review board-approved retrospective review of patients who underwent trapeziectomy and ligament reconstruction and tendon interposition (LRTI) was conducted. Patient demographics, visual analogue scale pain scores, grip strength, pinch strengths, and radial and palmar abduction were collected. The trapezial space ratio (TSR) was measured by the scaphometacarpal distance divided by the length of the capitate. Subsidence [(postoperative TSR - preoperative TSR)/preoperative TSR] was measured and classified as severe (≥70%) or mild to moderate (<70%). Median rate of subsidence increase was calculated. Conolly-Rath scores were used to evaluate the proportion of good outcomes in each group.
A total of 141 trapeziectomies with LRTI were included. Subsidence increased 6.7% (5.4% to 23.0%) per week before 16 weeks and 0.3% (0.1% to 0.8%) per week thereafter. Visual analogue scale pain scores were not significantly different between patients with severe or mild to moderate subsidence ( P = 0.25) 16 weeks after thumb mobilization. The proportion of good outcomes was comparable between the two groups ( P = 0.12). There was no correlation between subsidence and pain (ρ = -0.20; P = 0.24), grip (ρ = -0.02; P = 0.93), key (ρ = -0.13; P = 0.62), tripod (ρ = 0.16; P = 0.71), or index tip pinch strengths (ρ = -0.28; P = 0.43) or radial (ρ = -0.03; P = 0.92) or palmar (ρ = -0.15; P = 0.61) abduction.
Subsidence occurs in all patients after trapeziectomy and LRTI, stabilizing 16 weeks after mobilization. Degree of subsidence does not correlate with postoperative outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
对接受大多角骨切除术及韧带重建和肌腱植入术（LRTI）的患者进行了一项经机构审查委员会批准的回顾性研究。收集了患者的人口统计学资料、视觉模拟评分法疼痛评分、握力、捏力以及桡侧外展和掌侧外展情况。大多角骨间隙比率（TSR）通过舟状骨与掌骨间距离除以头状骨长度来测量。计算下沉率[（术后TSR - 术前TSR）/术前TSR]，并分为严重下沉（≥70%）或轻度至中度下沉（<70%）。计算下沉增加率的中位数。使用康诺利 - 拉特评分来评估每组中良好结果的比例。
共纳入141例接受LRTI的大多角骨切除术患者。在16周前，下沉每周增加6.7%（5.4%至23.0%），之后每周增加0.3%（0.1%至0.8%）。拇指活动16周后，严重下沉或轻度至中度下沉患者的视觉模拟评分法疼痛评分无显著差异（P = 0.25）。两组良好结果的比例相当（P = 0.12）。下沉与疼痛（ρ = -0.20；P = 0.24）、握力（ρ = -0.02；P = 0.93）、捏力（ρ = -0.13；P = 0.62）、三指捏力（ρ = 0.16；P = 0.71）或食指尖捏力（ρ = -0.28；P = 0.43）以及桡侧外展（ρ = -0.03；P = 0.92）或掌侧外展（ρ = -0.15；P = 0.61）均无相关性。
大多角骨切除术及LRTI后所有患者均会出现下沉，在活动16周后趋于稳定。下沉程度与术后结果无关。
临床问题/证据水平：风险，II级。
