Gellman H, Stetson W, Brumfield R H, Costigan W, Kuschner S H
Department of Orthopaedic Surgery, University of Arkansas, Little Rock 72205, USA.
Clin Orthop Relat Res. 1997 Sep(342):16-21.
Two hundred sixty-four patients with rheumatoid arthritis were treated with 901 Swanson silastic arthroplasties of the metacarpophalangeal joints. Average followup was 8 years with a minimum of 2 years. Preoperative ulnar deviation averaged 45 degrees and improved to an average of 15 degrees postoperatively. Active flexion arc averaged 40 degrees preoperatively and 50 degrees postoperatively, an increase of 10 degrees. The extensor lag postoperatively improved to 10 degrees from 50 degrees preoperatively, placing the arc of metacarpophalangeal joint motion between 10 degrees and 60 degrees flexion. Complications included dehiscence and delayed wound healing (2%), superficial infection (0.5%), deep infection (3%), and prosthetic fracture (14%). Subjectively, most patients thought that their postoperative function was improved. This was thought to be attributable in part to the correction of the ulnar deviation deformity of the fingers, and the shifting of the arc of motion of the metacarpophalangeal joints to one allowing increased metacarpophalangeal extension, thereby improving the opening capacity of the digits and the overall function of the hand.
264例类风湿性关节炎患者接受了901例掌指关节的斯旺森硅橡胶关节成形术治疗。平均随访8年，最短2年。术前平均尺偏45度，术后改善至平均15度。主动屈曲弧术前平均40度，术后50度，增加了10度。术后伸肌滞后从术前的50度改善至10度，使掌指关节活动弧在屈曲10度至60度之间。并发症包括裂开和伤口愈合延迟（2%）、浅表感染（0.5%）、深部感染（3%）和假体骨折（14%）。主观上，大多数患者认为其术后功能得到改善。这被认为部分归因于手指尺偏畸形的矫正，以及掌指关节活动弧向允许掌指关节伸展增加的方向转变，从而提高了手指的张开能力和手的整体功能。
