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大多角骨-第一掌骨间关节置换术:中期临床疗效与生存率

Trapeziometacarpal Joint Arthroplasty: Medium-Term Clinical Outcomes and Survival.

作者信息

Correia Guilherme, Ribeiro Elisabete, Correia Rodrigo, Ribau Melanie, Varanda Pedro, Ribeiro Juvenália, Rodrigues Luís Filipe

机构信息

Orthopaedics and Traumatology, Hospital de Braga, Braga, PRT.

Northern Rehabilitation Center, Centro Hospitalar Gaia Espinho, Gaia, PRT.

出版信息

Cureus. 2024 Nov 2;16(11):e72888. doi: 10.7759/cureus.72888. eCollection 2024 Nov.

Abstract

Trapeziometacarpal joint (TMC) arthroplasty (TMA) is a treatment option for failed symptomatic treatment of basal thumb arthritis. This study aimed to evaluate clinical and radiological outcomes and complications of Maïa™ prosthesis (Groupe Lépine, Genay, France) since its introduction in our institution with a minimum of three years follow-up. We performed a retrospective study of patients with TMA treated with Maïa prosthesis. Between 2015 and 2017, 22 patients (21 female and one male patient) were submitted to TMA with Maïa prosthesis, with a mean age of 60.1±6.6 (95%CI 57.1, 63.0) years old. According to the Eaton-Littler classification, four patients had rhizarthrosis grade II, and 18 had grade III. The average follow-up was 56.4±6.0 months (95%CI 53.8, 59.1). Mean TMC radial abduction was 53.0±15.9º (95%CI 43.1, 62.3), corresponding to 89% (95%CI 78, 100) of the contralateral side. The mean Kapandji score was 9.5±0.7 (95%CI 9.1, 9.8), corresponding to 98% (95%CI 94,100) of the opposite side. The mean key pinch was 4.7±1.4 kg (95%CI 3.9,5.4), and the mean grip strength was 8 kg (95%CI 4, 12) against 10 kg (95%CI 6, 14), which corresponded to 79% (95%CI 70, 88), and 81% (95%CI 66, 96) of the non-operated side force, respectively. The mean satisfaction score with the procedure was 8.8±2.3 (95%CI 7.6, 10.0) out of 10. The mean qDASH (Quick Disabilities of the Arm, Shoulder, and Hand) score was 25.8±30.0 (95%CI 10.0, 40.7). The total revision rate was 13.6% (two cases of dislocation and one for loosening of the trapezium cup). There were no infections. The survival rate of the implant was 86.4% (95%CI 78.3, 93.3) after a five-year follow-up. There is still limited information regarding the long-term results of TMA using the Maïa prosthesis. TMA is a technically demanding procedure with a significant learning curve. With this study, we report satisfactory medium-term results in terms of motion, strength, and patient satisfaction.

摘要

大多角骨-掌骨关节(TMC)置换术(TMA)是拇指基底关节炎症状性治疗失败后的一种治疗选择。本研究旨在评估Maïa™假体(法国热奈市勒皮纳集团)自引入我院并至少随访三年后的临床、放射学结果及并发症。我们对接受Maïa假体TMA治疗的患者进行了一项回顾性研究。2015年至2017年期间,22例患者(21例女性和1例男性)接受了Maïa假体TMA治疗,平均年龄为60.1±6.6岁(95%置信区间57.1, 63.0)。根据伊顿-利特勒分类法,4例患者为Ⅱ级拇指关节病,18例为Ⅲ级。平均随访时间为56.4±6.0个月(95%置信区间53.8, 59.1)。TMC桡侧外展平均为53.0±15.9°(95%置信区间43.1, 62.3),相当于对侧的89%(95%置信区间78, 100)。平均卡潘迪评分为9.5±0.7(95%置信区间9.1, 9.8),相当于对侧的98%(95%置信区间94, 100)。平均捏力为4.7±1.4 kg(95%置信区间3.9, 5.4),平均握力为8 kg(95%置信区间4, 12),对侧为10 kg(95%置信区间6, 14),分别相当于非手术侧力量的79%(95%置信区间70, 88)和81%(95%置信区间66, 96)。该手术的平均满意度评分为8.8±2.3(满分10分,95%置信区间7.6, 10.0)。平均手臂、肩部和手部快速残疾(qDASH)评分为25.8±30.0(95%置信区间10.0, 40.7)。总翻修率为13.6%(2例脱位和1例大多角骨杯松动)。无感染发生。五年随访后假体生存率为86.4%(95%置信区间78.3, 93.3)。关于使用Maïa假体进行TMA的长期结果的信息仍然有限。TMA是一项技术要求较高的手术,有显著的学习曲线。通过本研究,我们报告了在活动度、力量和患者满意度方面令人满意的中期结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/be66/11610771/8feb3aeb8189/cureus-0016-00000072888-i01.jpg

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