Kato Teiji, Ideo Katsumasa, Miyamoto Takeshi
Department of Orthopedic Surgery, Kato Orthopedic Clinic, Kikuyo-cho, Kikuchi-Gunn, Japan.
Department of Orthopedic Surgery, Kumamoto University, Chuo-ku, Kumamoto, Japan.
JB JS Open Access. 2025 Aug 22;10(3). doi: 10.2106/JBJS.OA.25.00147. eCollection 2025 Jul-Sep.
Carpometacarpal (CM) joint osteoarthritis of the thumb is characterized by pain and impaired thumb function in terms of pinch and range of motion. Here, we newly adopted a trapeziectomy with a graft-augmented ligament reconstruction procedure, in which the reconstructed ligament is reinforced using a half-slip extensor carpi radialis longus (ECRL) tendon.
From 2015 to 2022, 101 hands of 95 patients with CM joint osteoarthritis of the thumb underwent trapeziectomy with graft-augmented ligament reconstruction using the half-slip ECRL tendon to reconstruct the ligament. The reconstructed ligament was reinforced by wrapping 3 times with the half-slip ECRL tendon. All patients underwent a 1-year assessment, and 29 hands of 26 patients were followed up for >4 years postoperatively.
Motion pain, as assessed by visual analogue scale, was significantly improved from 56.9 ± 20.6 preoperatively to 4.2 ± 10.1 at the 1-year assessment (p < 0.001). Radial and palmar abduction also increased significantly from 46.0° ± 11.0° and 49.7° ± 8.8° preoperatively, respectively, to 58.4° ± 6.4° (p < 0.001) and 59.5° ± 6.3° (p < 0.001), respectively, at 12 months postoperatively. Both male and female tip pinch increased significantly from 4.2 ± 1.8 and 3.0 ± 1.4 preoperatively, respectively, to 6.1 ± 1.9 (p = 0.002) and 4.3 ± 1.4 (p < 0.001) at the 1-year postoperative evaluation. We observed no impingement of the first metacarpal and scaphoid bones due to sinking of the first metacarpal bone, and repeat surgery due to rupture of the reconstructed ligament or fractures at the bone hole, was not needed for the 101 hands followed for approximately 1 year and the 29 hands followed over 4 years.
Trapeziectomy combined with graft-augmented ligament reconstruction, using a reinforced half-slip ECRL tendon wrapped 3 times, may serve as an effective treatment option for primary thumb carpometacarpal osteoarthritis. This approach offers significant pain relief, improved range of motion and pinch strength, and prevents postoperative impingement of the first metacarpal across all Eaton stages in the short - medium term.
Therapeutic Level Ⅳ. See Instructions for Authors for a complete description of levels of evidence.
拇指腕掌关节骨关节炎的特征是疼痛，且拇指在捏取和活动范围方面的功能受损。在此，我们新采用了一种带移植物增强韧带重建的大多角骨切除术，其中重建韧带使用半腱桡侧腕长伸肌（ECRL）肌腱进行加强。
2015年至2022年期间，95例拇指腕掌关节骨关节炎患者的101只手接受了带移植物增强韧带重建的大多角骨切除术，使用半腱ECRL肌腱重建韧带。重建韧带用半腱ECRL肌腱缠绕3次进行加强。所有患者均接受了为期1年的评估，26例患者的29只手在术后随访超过4年。
通过视觉模拟量表评估的活动疼痛从术前的56.9±20.6显著改善至1年评估时的4.2±10.1（p<0.001）。桡侧外展和掌侧外展也分别从术前的46.0°±11.0°和49.7°±8.8°显著增加至术后12个月时的58.4°±6.4°（p<0.001）和59.5°±6.3°（p<0.001）。男性和女性的指尖捏力分别从术前的4.2±1.8和3.0±1.4显著增加至术后1年评估时的6.1±1.9（p=0.002）和4.3±1.4（p<0.001）。对于随访约1年的101只手和随访超过4年的29只手，我们未观察到因第一掌骨下沉导致的第一掌骨与舟状骨撞击，也未因重建韧带断裂或骨孔处骨折而需要再次手术。
大多角骨切除术联合使用缠绕3次的加强半腱ECRL肌腱进行移植物增强韧带重建，可能是原发性拇指腕掌关节骨关节炎的一种有效治疗选择。这种方法能显著缓解疼痛，改善活动范围和捏力，并在短期至中期内防止所有伊顿分期的术后第一掌骨撞击。
治疗性证据水平Ⅳ。有关证据水平的完整描述，请参阅作者指南。
