Hameed Iman, Tomkinson Ellen, Slevin Omer, McCombe David, Berger Anthony C, Tham Stephen K
Hand Surgery Unit, Department of Plastic Surgery, St Vincent's Hospital, Melbourne, Australia.
Victorian Hand Surgery Associates, Melbourne, Australia.
J Hand Surg Am. 2024 Dec;49(12):1219-1227. doi: 10.1016/j.jhsa.2024.07.024. Epub 2024 Sep 30.
The purpose of this study was to determine the long-term consequences of trapeziectomy and ligament reconstruction and tendon interposition (LRTI) for trapeziometacarpal osteoarthritis in patients aged less than 56 years.
A retrospective study was performed to investigate the outcome of trapeziectomy and LRTI with a follow-up period of greater than 5 years in patients aged less than 56 years at the time of surgery. Patients completed the Disabilities of Arm, Shoulder, and Hand (DASH), the Patient-Rated Wrist Evaluation (PRWE), and a 10-point visual analog score for pain (VAS). Objective assessments included thumb opposition, palmar and radial abduction angles, and grip, lateral key, and thumb tip pinch strengths. Radiographic assessments of the thumb carpometacarpal joint were performed in three planes, and the trapezial space and trapezial space to metacarpal height ratios were calculated.
Between January 2005 and December 2017, 105 patients were treated. Forty-eight patients with 58 thumbs returned for review. The mean patient age at the time of surgery was 52.5 years, and 96% of the patients were women. The mean follow-up period from surgery was 11 years. The mean VAS score was 1. A significant association was found between younger age at the time of surgery and increased proximal migration of the metacarpal, between high VAS pain scores and high PRWE and DASH scores, weak grip, lateral key pinch and thumb tip pinch strength, and Kapandji score, and between the follow-up period and increasing VAS pain, PRWE, and DASH scores.
Trapeziectomy and LRTI are effective procedures for patients aged less than 56 years. The benefits of surgery should be balanced against the deterioration in the outcome measures of DASH and PRWE and increasing VAS scores with increasing intervals from surgery.
TYPE OF STUDY/LEVEL EVIDENCE: Therapeutic IV.
本研究旨在确定对于年龄小于56岁的拇指腕掌关节骨关节炎患者，行大多角骨切除术及韧带重建和肌腱植入术（LRTI）的长期后果。
进行一项回顾性研究，以调查手术时年龄小于56岁的患者行大多角骨切除术及LRTI且随访期超过5年的结果。患者完成上肢、肩部和手部功能障碍（DASH）量表、患者自评腕关节评估（PRWE）以及10分疼痛视觉模拟评分（VAS）。客观评估包括拇指对掌、掌侧和桡侧外展角度，以及握力、侧捏力和拇指尖捏力。在三个平面上对拇指腕掌关节进行影像学评估，并计算大多角骨间隙以及大多角骨间隙与掌骨高度的比值。
2005年1月至2017年12月期间，共治疗了105例患者。48例患者的58个拇指接受复查。手术时患者的平均年龄为52.5岁，96%为女性。手术至随访的平均时间为11年。平均VAS评分为1分。发现手术时年龄较小与掌骨近端移位增加之间、VAS疼痛评分高与PRWE和DASH评分高、握力弱、侧捏力和拇指尖捏力以及Kapandji评分之间、随访期与VAS疼痛、PRWE和DASH评分增加之间存在显著相关性。
对于年龄小于56岁的患者，大多角骨切除术及LRTI是有效的手术方式。手术的益处应与DASH和PRWE结果指标的恶化以及随着手术间隔时间增加VAS评分升高相权衡。
研究类型/证据级别：治疗性IV级。
