Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia.
Discipline of Surgery, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
J Hand Surg Asian Pac Vol. 2023 Jun;28(3):409-414. doi: 10.1142/S2424835523500443. Epub 2023 Jul 24.
Arthritis of the distal interphalangeal joint (DIPJ) can result in significant functional limitations and pain. While arthrodesis is the most common surgical intervention, this can decrease grip strength and have other limitations. DIPJ arthroplasty may be an appealing alternative in select patient with this study aiming to review the outcomes of this procedure. A search was conducted according to PRISMA guidelines using PubMed, Embase and Ovid Medline from date of inception to April 2022. Relevant studies were included if they reported on complications and functional outcomes of DIPJ arthroplasty. Data was then extracted and analysed. Seven studies were included including 171 patients with 269 digits. The mean age was 62.1 years, with 81% of the cohort being female. The indication for surgery was osteoarthritis in 97% of patients. Surgical approaches varied from dorsal transverse, dorsal T-incision, dorsal H-incision to radial incisions. A silicone implant was used in all patients. A total of 97.7% of patients were satisfied with their outcome, and pain improved or eliminated in all patients where it was reported. Joint stability was noted in 97.4% of cases. The mean preoperative DIPJ range of motion was 24° and improved to 36° post-operation. The mean preoperative extensor lag was 24° and reduced to 13° post operation. The rate of re-operation was 7.1%. DIPJ arthroplasty may be a viable alternative to arthrodesis in certain settings, providing high patient satisfaction, improvements in digital range of motion and relief of pain. However, the available literature is sparse, and limited by low-quality studies and heterogenous outcome reporting. Level III (Therapeutic).
远节指间关节（DIPJ）关节炎可导致明显的功能受限和疼痛。虽然关节融合术是最常见的手术干预措施，但它会降低握力并存在其他限制。DIPJ 关节成形术可能是一种有吸引力的选择，特别是对于有此需求的患者。本研究旨在回顾该手术的结果。按照 PRISMA 指南，我们在 PubMed、Embase 和 Ovid Medline 上进行了检索，检索时间从建库开始至 2022 年 4 月。如果研究报告了 DIPJ 关节成形术的并发症和功能结果，则纳入相关研究。然后提取和分析数据。共纳入 7 项研究，包括 171 例患者的 269 个手指。平均年龄为 62.1 岁，81%的患者为女性。97%的患者手术指征为骨关节炎。手术入路从背侧横行、背侧 T 形切口、背侧 H 形切口到桡侧切口不等。所有患者均使用硅酮植入物。97.7%的患者对手术结果满意，且所有报告疼痛的患者疼痛均得到改善或消除。97.4%的病例关节稳定性良好。术前 DIPJ 活动度的平均范围为 24°，术后改善至 36°。术前伸肌滞后的平均范围为 24°，术后减少至 13°。再手术率为 7.1%。在某些情况下，DIPJ 关节成形术可能是关节融合术的可行替代方案，可提供较高的患者满意度，改善手指活动度并缓解疼痛。然而，现有文献较少，受到低质量研究和结果报告异质性的限制。III 级（治疗性）。
