Trapezio-metacarpal arthrodesis: procedure and results

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• 作者：Adolfo Galán ; Javier R. Arenas…
• 关键词：Trapezio ; metacarpal arthrodesis ; Basal thumb osteoarthritis ; Percutaneous graft ; Rizarthrosis
• 刊名：European Journal of Orthopaedic Surgery & Traumatology
• 出版年：2015
• 出版时间：April 2015
• 年：2015
• 卷：25
• 期：3
• 页码：483-488
• 全文大小：1,027 KB
• 参考文献：1. Armstrong, AL, Hunter, JB, Davis, TR (1994) The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg Br 19: pp. 340-341 CrossRef
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  3. Kenniston, JA, Bozentka, DJ (2008) Treatment of advanced carpometacarpal joint disease: arthrodesis. Hand Clin 24: pp. 285-294 CrossRef
  4. Kriegs-Au, G, Petje, G, Fojtl, E, Ganger, R, Zachs, I (2004) Ligament reconstruction with or without tendon interposition to treat primary thumb carpometacarpal osteoarthritis. A prospective randomized study. J Bone Joint Surg Am 86A: pp. 209-218
  5. Raven, EE, Kerkhoffs, GM, Rutten, S, Marsman, AJ, Marti, RK, Albers, GH (2007) Long term results of surgical intervention for osteoarthritis of the trapeziometacarpal joint : comparison of resection arthroplasty, trapeziectomy with tendon interposition and trapezio-metacarpal arthrodesis. Int Orthop 31: pp. 547-554 CrossRef
  6. Martou, G, Veltri, K, Thoma, A (2004) Surgical treatment of osteoarthritis of the carpometacarpal joint of the thumb: a systematic review. Plast Reconstr Surg 114: pp. 421-432 CrossRef
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  8. Wajon, A, Carr, E, Edmunds, I, Ada, L (2009) Surgery for thumb trapeziometacarpal joint osteoarthritis. Cochrane Database Syst Rev 4: pp. CD004631
  9. Rizzo, M, Moran, SL, Shin, AY (2009) Long-term outcomes of trapeziometacarpal arthrodesis in the management of trapeziometacarpal arthritis. J Hand Surg Am 34: pp. 20-26 CrossRef
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  11. Goldfarb, CA, Stern, PJ (2002) Indications and techniques for thumb carpometacarpal arthrodesis. Tech Hand Up Extrem Surg 6: pp. 178-184 CrossRef
  12. Bamberger, HB, Stern, PJ, Kiefhaber, TR, McDonough, JJ, Cantor, RM (1992) Trapeziometacarpal joint arthrodesis: a functional evaluation. J Hand Surg Am 17: pp. 605-611 CrossRef
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  14. Fulton, DB, Stern, PJ (2001) Trapeziometacarpal arthrodesis in primary osteoarthritis: a minimum two-year follow-up study. J Hand Surg Am 26: pp. 109-114 CrossRef
  15. Forseth, MJ, Stern, PJ (2003) Complications of trapeziometacarpal arthrodesis using plate and screw fixation. J Hand Surg Am 28: pp. 342-345 CrossRef
  16. Bicknell, RT, MacDermid, J, Roth, JH (2007) Assessment of thumb metacarpophalangeal joint arthrodesis using a single longitudinal K-wire. J Hand Surg Am 32: pp. 677-684 CrossRef
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  18. Hirschfeld, M, Galán, A, Arenas, J, águila, B, Benítez-Parejo, N, Costa, JA, Guerado, E (2014) Inter-observer agreement on the Eaton-Littler classification of trapeziometacarpal joint osteoarthritis. Rev Esp Cir Ortop Traumatol 58: pp. 237-241
  19. Rosales, RS, Delgado, EB, Lastra-Bosch, ID (2002) Evaluation of the Spanish version of the DASH and carpal tunnel syndrome health-related quality-of-life instruments: cross-cultural adaptation process and r
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgical Orthopedics
  Traumatic Surgery
  
• 出版者：Springer Paris
• ISSN：1432-1068

文摘

The high prevalence of trapezio-metacarpal joint (TMJ) osteoarthritis leads to develop techniques to improve surgical outcomes when conservative treatment has failed. We have evaluated 18 patients with Eaton III TMJ osteoarthritis, who underwent an arthrodesis. Using a dorsal-radial curved shaped skin incision the TMJ was exposed through the space between the abductor pollicis longus and the extensor pollicis brevis muscles. The articular capsule was divided and the TMJ was opened. Neat curettage was then performed in both joint surfaces by removing all the articular cartilage until some cancellous bone hints appeared underneath. The joint was then fixed in the optimal position by a 1.6?mm Kirschner wire and a 1.1?mm guide wire. A cannulated drill for the guide wire was used and matched to a cannulated lag screw. Then, a cylinder-shaped cancellous bone autograft harvested from the distal radius by a percutaneous approach was applied in the hole by drilling backwards in order to spread the bone about onto the hole walls. The joint was then definitively fixed by the cannulated lag screw. The K wires were removed by that time. DASH score changed from an average of 68 in the preoperative assessment to 39.4 at the end of the evolution time. The evolution of pain has decreased from 9.2 points preoperatively to 3.9 points in the postoperative using the visual analogue scale. In terms of mobility, it has decreased from 4 points preoperatively to 3.9 postoperatively, 14 patients got opposition of the thumb to the fifth finger, two of them to the head of the fifth metacarpal bone, one patient to the fourth finger, and one to the third. This slight decrease of mobility had no effect on performing activities of daily life, as expressed by the patients. The grip strength increased from 17 to 21.7?kg and the thumb opposition from 7.8 to 11.2?kg. All patients, except one, would have the operation again after knowing the final results. This patient said that results did not meet previous expectations. On the radiographic evaluation, consolidation has been achieved in 17 patients. When thumb carpo-metacarpal arthrodesis is indicated, the procedure provides a reliable and lasting treatment with satisfactory results. The development of new implants and the possibility of introducing autologous graft percutaneously as is described using this technique leads to improve the results.