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[拇指腕掌关节Touch®假体的短期疗效]

[Short-term Outcomes of Touch® Prosthesis for Thumb Carpometacarpal Joint].

作者信息

Filuś D, Pavličný R

机构信息

Ortopedické oddělení, Karvinská Hornická Nemocnice, a.s., Karviná - Nové Město.

出版信息

Acta Chir Orthop Traumatol Cech. 2023;90(4):277-282.

Abstract

PURPOSE OF THE STUDY Rhizarthrosis, a degenerative condition of the carpometacarpal joint of the thumb, affects mainly women. Surgical treatment is indicated once the non-operative treatment fails. Thumb carpometacarpal joint total arthroplasty constitutes one of the surgical treatment options. This study aims to evaluate the short-term functional and radiological outcomes of Touch® prosthesis with a minimum follow-up period, namely two years after surgery. MATERIAL AND METHODS The study presents the outcomes of a group of 56 endoprostheses implanted in 48 patients. The dual mobility Touch® prosthesis is evaluated. The group consisted of 41 women and 7 men, with the median age of the patients being 62 years. The patients were indicated for surgery after the non-operative treatment had failed. All of them suffered from stage II - IV osteoarthritis according to the Eaton-Littler classification. The range of motion - the opposition was assessed using the Kapandji score. The function and the pain were evaluated with the DASH questionnaire preoperatively and at 3 months, 6 months, 1 year and 2 years postoperatively. RESULTS After 24 months, 91.1% (51 patients) were satisfied with the surgical outcome. Altogether 8.9% of patients (5 patients) experienced postoperative exercise-induced pain, limitation of movement of the CMC joint or hand weakness. No dislocation or endoprosthetic loosening occurred in the evaluated group. Primary wound healing was reported in all patients and no superficial or deep infection was observed. The mean DASH score was 65.3 points preoperatively; at the 2-year follow-up, the mean score decreased to 10.8 points. The pain assessed in question 24 of the DASH questionnaire decreased from the mean value of 4.45 points to 1.2 points. After two years, the range of motion of all patients was X/X according to Kapandji. DISCUSSION There are plenty of surgical techniques to manage rhizarthrosis. All types of surgery have their pros and cons. Most endoprostheses used nowadays show good short-term, mid-term, and some of them even long-term outcomes in terms of survival. The Touch® prosthesis, characterized by dual mobility, is the 3rd generation thumb CMC prosthesis and in our study achives comparable short-term outcomes to those reported by international literature. The use of the dual mobility design appears to be effective in reducing the dislocation rate. CONCLUSIONS The Touch® thumb CMC prosthesis achieves very good short-term functional and radiological outcomes. We can recommend the prosthesis provided the patients are followed-up for more than two years after surgery. Key words: rhizarthrosis, osteoarthritis, endoprosthesis of the carpometacarpal joint, dual mobility, Touch®.

摘要

研究目的

拇指掌指关节的退行性疾病——拇指腕掌关节病,主要影响女性。非手术治疗失败后需进行手术治疗。拇指腕掌关节全关节置换术是手术治疗选择之一。本研究旨在评估Touch®假体在最短随访期(即术后两年)的短期功能和影像学结果。

材料与方法

本研究呈现了一组植入48例患者体内的56个假体的结果。对双动Touch®假体进行评估。该组包括41名女性和7名男性,患者的中位年龄为62岁。患者在非手术治疗失败后接受手术。根据伊顿-利特勒分类,所有患者均患有II - IV期骨关节炎。使用卡潘迪评分评估活动范围——对掌功能。术前以及术后3个月、6个月、1年和2年使用DASH问卷评估功能和疼痛情况。

结果

24个月后,91.1%(51例患者)对手术结果满意。共有8.9%的患者(5例)术后出现运动诱发疼痛、腕掌关节活动受限或手部无力。评估组未发生脱位或假体松动。所有患者均实现一期伤口愈合,未观察到浅表或深部感染。术前DASH平均评分为65.3分;在2年随访时,平均评分降至10.8分。DASH问卷第24题评估的疼痛从平均4.45分降至1.2分。两年后,根据卡潘迪评分,所有患者的活动范围均为X/X。

讨论

有多种手术技术可用于治疗拇指腕掌关节病。所有类型的手术都有其优缺点。如今使用的大多数假体在生存率方面显示出良好的短期、中期,甚至一些假体显示出长期效果。具有双动特性的Touch®假体是第三代拇指腕掌关节假体,在我们的研究中,其短期结果与国际文献报道的结果相当。双动设计的使用似乎能有效降低脱位率。

结论

Touch®拇指腕掌关节假体取得了非常好的短期功能和影像学结果。如果患者术后随访超过两年,我们可以推荐使用该假体。

关键词

拇指腕掌关节病;骨关节炎;腕掌关节假体;双动;Touch®

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