Chamay A, Piaget-Morerod F
Division of Plastic and Reconstructive Surgery, Hôpital Cantonal Universitaire, Geneva, Switzerland.
J Hand Surg Br. 1994 Aug;19(4):489-97. doi: 10.1016/0266-7681(94)90215-1.
Over a 10-year period, 32 trapeziometacarpal (TM) joint fusions were performed in 29 patients, and reviewed. Pin fixation with tension band wiring was used in 14 cases, screws in eight cases, a plate in six cases, K-wires in three cases and staple fixation in one case. None was bone grafted. Splinting was applied for 4 to 5 weeks. There were four cases of delayed union (more than 2 months) and four cases of non-union requiring re-operation (12.5%). The average follow-up was 6 years and 7 months. Grip (26.5 kg) and pinch (4.9 kg) strength were respectively 7% and 18% less than the normal contralateral side. In bilateral osteoarthritis, grip and pinch were stronger than the contralateral side. Joint angulations measured on X-ray films showed for the peritrapezial joint an 18 degrees arc in flexion-extension (a reduction of 64% compared to the contralateral side) and 11 degrees of arc in abduction-adduction (a reduction of 72%). MP joint mobility increased in extension (160%), in flexion (23%), in abduction (120%), in adduction (157%). Despite the marked decrease in motion, subjective functional complaints were minimal. 78.1% of the patients were fully satisfied, 15.6% partly satisfied, and 6.3% dissatisfied. Pain was absent in 50% of the cases and very mild in 40.7%. Three patients complained of discomfort. Eight patients were noted to have osteoarthritic changes in the scaphotrapezial joint.
在10年期间，对29例患者实施了32例大多角骨-第一掌骨（TM）关节融合术，并进行了回顾性研究。14例采用克氏针张力带固定，8例采用螺钉固定，6例采用钢板固定，3例采用克氏针固定，1例采用U形钉固定。均未进行植骨。使用夹板固定4至5周。有4例延迟愈合（超过2个月），4例骨不连需要再次手术（12.5%）。平均随访时间为6年7个月。握力（26.5千克）和捏力（4.9千克）分别比健侧低7%和18%。在双侧骨关节炎患者中，握力和捏力比健侧更强。X线片测量的关节角度显示，大多角骨周围关节屈伸弧度为18度（比健侧减少64%），内收外展弧度为11度（比健侧减少72%）。掌指关节活动度在伸展时增加（160%），屈曲时增加（23%），外展时增加（120%），内收时增加（157%）。尽管活动度明显降低，但主观功能主诉很少。78.1%的患者完全满意，15.6%部分满意，6.3%不满意。50%的病例无疼痛，40.7%的病例疼痛非常轻微。3例患者抱怨有不适感。8例患者被发现舟大多角骨关节有骨关节炎改变。
