Sulje Zoran, Starčević Damir, Aljinović Ana, Barbarić Starčević Katarina
Department of Orthopedic Surgery, Zagreb University Hospital Center, Zagreb, Croatia.
Akromion Special Hospital for Orthopedic Surgery, Krapinske Toplice, Croatia.
Acta Clin Croat. 2024 Oct;63(2):393-402. doi: 10.20471/acc.2024.63.02.16.
The first carpometacarpal joint is the second most common joint affected by degenerative arthritis. The prevalence of the first carpometacarpal joint arthritis increases with age, especially in postmenopausal women. Ligamentous laxity or injury of the first carpometacarpal joint is thought to be the starting point of development of degenerative changes, accompanied with altered biomechanics of the thumb. As the disease progresses, the joint is destroyed and the thumb and hand function are deteriorating. Although many patients, in different stages of disease, experience pain relief with conservative treatment, surgery is often needed. Decision on the type of surgical procedure depends on the age of the patient, functional demands, and stage of the disease. In early stages of the disease, stabilization of the first carpometacarpal joint, extension osteotomy of the first metacarpal and arthroscopic procedures are used. These are joint-preserving procedures, and they slow down progression of the disease and reduce symptoms. In late stages of the disease, joint arthroplasty procedures and first carpometacarpal arthrodesis are performed. In recent years, late stages of the disease can also be treated arthroscopically. This paper describes different surgical methods, their advantages and drawbacks, with respect to different stages of the disease.
第一掌腕关节是退行性关节炎累及的第二常见关节。第一掌腕关节关节炎的患病率随年龄增长而增加，尤其是在绝经后女性中。第一掌腕关节的韧带松弛或损伤被认为是退行性改变发展的起点，同时伴有拇指生物力学改变。随着疾病进展，关节被破坏，拇指和手部功能逐渐恶化。尽管许多处于疾病不同阶段的患者通过保守治疗可缓解疼痛，但通常仍需要手术。手术方式的选择取决于患者年龄、功能需求和疾病阶段。在疾病早期，采用第一掌腕关节稳定术、第一掌骨延长截骨术和关节镜手术。这些是保留关节的手术，可减缓疾病进展并减轻症状。在疾病晚期，进行关节置换手术和第一掌腕关节融合术。近年来，疾病晚期也可通过关节镜治疗。本文描述了针对疾病不同阶段的不同手术方法及其优缺点。
