Chirurgie De La Main最新文献

Introduction

The scaphoid is the most frequently fractured carpal bone. Most of its surface is covered by articular cartilage, which limits the space for the entrance of nutritious vessels. This leads to a precarious irrigation, especially at its proximal pole. A fracture further impairs bloodflow, which may lead to delayed union, nonunion, or even avascular necrosis of the proximal fragment. The proximal scaphoid hemiarthroplasty is one of the techniques available to treat the scaphoid proximal pole osteonecrosis. This part of the bone is substituted by a pyrocarbon implant that aims to maintain proximal carpal row kinematics and prevent carpal collapse, minimizing the risk for symptomatic osteoarthrosis. The goal of our study was to evaluate the long-term results of proximal scaphoid hemiarthroplasty for posttraumatic avascular necrosis of the scaphoid's proximal pole.

Materials and methods

Twelve patients who underwent this procedure were identified, and the average follow-up time was 6.5 years (range 5–8 years). All patients were male, with a mean age of 39 years (ranging from 28 to 55). In 8 patients the non-dominant limb was the one affected. The procedure was carried out through a dorsal approach and all patients were subjected to the same rehabilitation protocol. Functional results were determined using the QuickDASH and Mayo Wrist Score.

Results

There were no immediate postoperative complications such as infection or dislocation of the implant. All patients presented with peri-implant osteolysis at follow-up. None of the patients was forced to abandon their previous professional activity, even though 50% required some type of adaptation necessary at their workplace. The average functional capacity was, according to the Mayo Wrist Score, of 67.5 points (range 50–80), corresponding to a “Satisfactory” degree of function. From the application of the QuickDASH resulted an average disability of 25 (range 3–47.7).

Discussion

All patients mentioned as having the biggest disability with working with, or carrying, heavy objects. The results of this series are in line with previously published studies about this technique.

Conclusion

Hemiarthroplasty with a pyrocarbon implant is a safe technique for the treatment of post-fracture avascular necrosis of the scaphoid pole. This technique allowed for a satisfactory functional result at a mean follow-up of 6.5 years.

Introduction

L’objectif de ce travail était de juger avec recul les résultats du traitement de la rhizarthrose par double ostéotomie et rotation en îlot du bloc articulaire trapézométacarpien. Sur une série continue de 74 cas, nous avons revu les patients qui avaient atteint un recul d’au moins 10 ans.

Matériel

Entre février 2000 et mars 2005 nous avons opéré 22 patients atteints de rhizarthrose, 20 femmes et 2 hommes, d’âge moyen 43 ans (18 à 63), 2 cas bilatéraux soit 24 cas. L’indication chirurgicale était retenue pour des douleurs trapézométacarpiennes dans tous les cas, dans 4 cas l’instabilité était gênante. La mobilité était préservée (Kapandji 9 3) mais la force nettement diminuée comparée au côté controlatéral (grasp 43 %, key-grip 55 %, pinch 50 %). Le bilan radiographique préopératoire montrait dans tous les cas une instabilité avec subluxation de la base du premier métacarpien, stade 2 et 3 de Dell.

Résultats

Aucun patient n’a été perdu de vue, 16 patients (18 cas) ont été revus, 3 patients ont été joints par téléphone. Trois échecs ont nécessité une reprise chirurgicale dans les 18 premiers mois postopératoires (2 trapézectomies partielles, 1 hémi-arthroplastie de M1) les résultats sont stables au recul. Pour les 18 cas revus, le recul moyen est de 13 ans (10 à 15). La douleur est côté EVA - 0,5 (0 à 5), QuickDASH à 6 (0 à 22). La mobilité est selon Kapandji à 9 en antépulsion et à 3 en rétropulsion. La force moyenne comparée au côté controlatéral est pour le grasp - 330 %, pour la key-grip - 100 % et pour le pinch - 98 %. Sur le plan radiographique, l’articulation trapézométacarpienne a été stabilisée de manière constante. L’interligne articulaire est stable 10 fois, diminué dans son épaisseur 8 fois. L’interligne STT est pincé 8 fois sans retentissement clinique.

Discussion

Les résultats cliniques avec un recul moyen de 13 ans montrent l’intérêt de cette intervention chez les patients jeunes. La force au grasp est le point fort de cette intervention, toutefois la comparaison au côté controlatéral est discutable chez ces patients présentant souvent une rhizarthrose controlatérale. Avec 74 cas nous confirmons la fiabilité de la technique chirurgicale qui est délicate.

Conclusion

Nous préconisons cette intervention chez les patients de moins de 50 ans, aux stades 1 et 2 de Dell, plus particulièrement lorsque ces patients souhaitent poursuivre des activités de force.

Thumb base arthritis is a common condition. Arthroscopic or arthroscopic assisted procedures offer better visualisation, less invasiveness, faster recovery, and help to guide the treatment decision.

From Apr 2002 to Aug 2013, 76 thumb base arthroscopic debridement & synovectomy was performed in 65 patients (female 51, male 14) at the average age of 56. All patients failed nonoperative care for 6 months. They were follow-up on average of 59 months. Thirty-eight cases were Eaton & Littler stage II, 36 stage III, I stage IV and I stage I. The operation was done under local or regional anaesthesia. Synovectomy, debridement of frayed capsule and radio-frequency ablation were done in all, loose bodies were removed in 25, and thermal shrinkage was done in 30 cases. Post-thermal shrinkage immobilisation was given for 3–6 weeks. Twelve cases had smoothening of the bony surface & prominent osteophytes.

Sixty-nine cases experienced pain relief after the operation. Twenty scored excellent while 14 good results. Mean grip strength of 88.3% of the contralateral side while pinch power of 81.7%. Kapandji index was 8. DASH score was 26.5. Patient satisfaction was 77/100. There was no complication encountered. Seven patients requested the same operation on the other thumb after the operation. Three requested repeating the same operation on the same thumb as pain relief lasted only for 1–3 years. Better outcomes were found to be statistically related to bone surface smoothening, or thermal shrinkage and immobilisation for ≥ 4 weeks. Arthroscopic surgery on thumb base arthritis is a safe, easy and feasible buy time surgery.

Long-term results of arthroscopic debridement and synovectomy, the surgical techniques, and the examples of arthroscopic assisted procedures at the thumb base were also demonstrated and discussed.