From the Departments of Surgery (Plastic Surgery) and Orthopedic Surgery, University of Minnesota Medical Center.
the Departments of Orthopedic Surgery.
Plast Reconstr Surg. 2023 Aug 1;152(2):375-382. doi: 10.1097/PRS.0000000000010394. Epub 2023 Mar 14.
Basal joint arthritis is a common form of osteoarthritis. There is no consensus procedure for maintenance of trapezial height following trapeziectomy. Suture-only suspension arthroplasty (SSA) is a simple method for stabilizing the thumb metacarpal following trapeziectomy.
This single-institution, prospective, cohort study compares trapeziectomy followed by either ligament reconstruction with tendon interposition (LRTI) or SSA for the treatment of basal joint arthritis. Patients underwent LRTI or SSA from May of 2018 to December of 2019. Visual analogue scale pain scores; Disabilities of the Arm, Shoulder and Hand questionnaire functional scores; clinical thumb range of motion, pinch, and grip strength data; and patient-reported outcomes were recorded and analyzed preoperatively and at 6 weeks and 6 months postoperatively.
Total number of study participants was 45 (LRTI, n = 26; SSA, n = 19). Mean ± SE age was 62.4 ± 1.5 years; 71% were female patients; and 51% underwent surgery on the dominant side. Visual analogue scale scores improved for LRTI and SSA ( P < 0.0001) over 6 months, with no differences between groups at any time point ( P > 0.3). Disabilities of the Arm, Shoulder and Hand questionnaire scores improved for LRTI and SSA over 6 months ( P < 0.0001), with no differences between groups at any time point ( P > 0.3). Following SSA, opposition improved ( P = 0.02), but not as well for LRTI ( P = 0.16). Grip and pinch strength decreased following LRTI and SSA at 6 weeks but recovered similarly for both groups over 6 months. Patient-reported outcomes were generally no different between groups at all time points.
LRTI and SSA are similar procedures following trapeziectomy relative to pain, function, and strength recovery.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
基底部关节关节炎是一种常见的骨关节炎形式。在手切除术后，对于 trapezial 高度的维持没有达成共识的程序。缝线仅悬吊关节成形术 (SSA) 是在手切除术后稳定拇指掌骨的一种简单方法。
本单机构、前瞻性队列研究比较了在手切除术后行韧带重建伴腱间插入术 (LRTI) 或 SSA 治疗基底部关节炎的情况。患者于 2018 年 5 月至 2019 年 12 月行 LRTI 或 SSA。记录并分析术前、术后 6 周和 6 个月的视觉模拟评分疼痛；上肢功能障碍问卷 (DASH) 功能评分；拇指临床活动范围、捏力和握力数据；以及患者报告的结果。
研究参与者总数为 45 例（LRTI，n = 26；SSA，n = 19）。平均 ± SE 年龄为 62.4 ± 1.5 岁；71%为女性患者；51%在优势侧手术。LRTI 和 SSA 的视觉模拟评分在 6 个月内均有所改善（P < 0.0001），但在任何时间点两组之间均无差异（P > 0.3）。LRTI 和 SSA 的 DASH 评分在 6 个月内均有所改善（P < 0.0001），但在任何时间点两组之间均无差异（P > 0.3）。在手切除术后行 SSA 可改善对掌（P = 0.02），但 LRTI 效果较差（P = 0.16）。LRTI 和 SSA 后握力和捏力在 6 周时下降，但两组在 6 个月时恢复情况相似。患者报告的结果在所有时间点两组之间通常没有差异。
在手切除术后，LRTI 和 SSA 是两种类似的手术，在疼痛、功能和力量恢复方面没有差异。
临床问题/证据水平：治疗性，II 级。
