Ruff Landan R, Delgadillo Blake E, El-Bahri George F
Orthopedic Surgery, Lake Erie College of Osteopathic Medicine, Bradenton, USA.
Orthopedic Surgery, Bahri Orthopedics and Sports Medicine Clinic, Jacksonville, USA.
Cureus. 2024 May 13;16(5):e60216. doi: 10.7759/cureus.60216. eCollection 2024 May.
Arthritis of the first carpometacarpal (CMC) joint is a common pathology hand surgeons encounter. Treatment begins with conservative measures, but when they fail, surgery is a viable option for providing relief to patients. The most widely used surgical technique is CMC arthroplasty with ligament reconstruction and tendon interposition (LRTI). However, more novel techniques such as trapeziectomy with suspensionplasty are gaining popularity. When surgical measures fail, it is important to identify the mechanism of failure and proper treatment options. There are multiple options for revision surgery at the surgeon's disposal, with no consensus on a superior technique. This case illustrates a patient with painful subsidence secondary to a traumatic collapse of the first CMC joint eight months status post suspensionplasty with trapeziectomy. After conservative measures failed to provide relief, it was decided that a surgical revision was appropriate. The surgeon chose to move forward with suture button suspensionplasty, as it has multiple advantages over LRTI. In the short-term follow-up after revision, the patient experienced improvements in pain and range of motion, along with radiographic evidence of proper alignment of the first metacarpal without subsidence. Regarding the treatment of a case such as this, the authors believe this case should serve as a reference that may be used by future physicians when deciding which surgical technique to employ for the revision of a traumatically collapsed first CMC joint after trapeziectomy with CMC joint suspensionplasty.
第一腕掌（CMC）关节关节炎是手外科医生常见的病症。治疗首先采取保守措施，但如果保守治疗失败，手术是为患者缓解症状的可行选择。最常用的手术技术是带韧带重建和肌腱植入的CMC关节成形术（LRTI）。然而，诸如梯形切除术加悬吊成形术等更新颖的技术正越来越受欢迎。当手术措施失败时，识别失败机制和合适的治疗选择很重要。外科医生有多种翻修手术选择，对于哪种技术更优越尚无共识。本病例展示了一名患者，在梯形切除术加悬吊成形术后八个月，因第一CMC关节创伤性塌陷继发疼痛性下沉。保守治疗未能缓解症状后，决定进行手术翻修是合适的。外科医生选择进行缝线纽扣悬吊成形术，因为它相对于LRTI有多个优点。在翻修后的短期随访中，患者疼痛和活动范围有所改善，同时影像学显示第一掌骨排列正确且无下沉。关于此类病例的治疗，作者认为本病例可作为未来医生在决定采用何种手术技术对梯形切除术加CMC关节悬吊成形术后创伤性塌陷的第一CMC关节进行翻修时的参考。
