拇指掌指关节置换术后的并发症和意外再手术

The Journal of Hand Surgery Pub Date : 2024-01-03 DOI:10.1016/j.jhsa.2023.11.024

Ingmar W.F. Legerstee, Oscar Y. Shen, Kevin Kooi, Yannick A.J. Hoftiezer, Kyle R. Eberlin, Neal C. Chen

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引用次数: 0

摘要

目的拇指掌指关节（MCP）的关节置换术是治疗关节炎或不稳定的常见手术。有关拇指 MCP 关节置换术后硬件并发症和不愈合率的研究报告样本量较小。我们的目的是描述接受拇指 MCP 关节置换术的患者的硬件并发症发生率、不愈合率以及实现愈合的拇指数量。方法在美国一个大都会地区的 5 家城市医院的数据库中搜索了 2004 年 1 月 1 日至 2020 年 1 月 1 日期间接受拇指 MCP 关节置换术的患者。在查阅患者病历后，我们确定了 122 名接受过 MCP 关节置换术且随访至少 90 天的拇指患者。主要结果是硬件并发症和不愈合后的非计划再手术。其次，报告了张力带和螺钉固定关节置换术组获得放射学结合的拇指数量。结果122个拇指中有22个（18%）在拇指MCP关节置换术后出现了硬件并发症，122个拇指中有11个（9%）出现了不愈合。接受螺钉固定关节置换术的患者没有出现硬件并发症和随后的硬件移除事件。张力带关节置换术组的不愈合率为9/65（14%），螺钉固定关节置换术组的不愈合率为2/45（4%）。结论我们的数据表明，与张力带关节置换术相比，螺钉固定术的硬件并发症更少，再次手术率更低。

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Complications and Unplanned Reoperation After Thumb Metacarpophalangeal Arthrodesis

Purpose

Arthrodesis of the metacarpophalangeal (MCP) joint of the thumb is a common procedure to treat arthritis or instability. Studies reporting hardware complications and nonunion rates after thumb MCP joint arthrodesis report on small sample sizes. We aimed to describe the hardware complication rate, the nonunion rate, and the number of thumbs that achieve union among patients undergoing thumb MCP joint arthrodesis.

Methods

A database spanning 5 urban hospitals in a single metropolitan region in the United States was searched for patients who underwent thumb MCP joint arthrodesis between January 1, 2004 and January 1, 2020. After reviewing patient records, we identified 122 thumbs that underwent MCP joint arthrodesis and had a minimum follow-up of 90 days. The primary outcome was unplanned reoperation after hardware complications and nonunion. Second, the number of thumbs that achieved radiographic union was reported for the tension band and screw fixation arthrodesis group.

Results

Twenty-two (18%) out of 122 thumbs had hardware complications after thumb MCP joint arthrodesis, and 11 (9%) out of 122 thumbs developed a nonunion. Patients who underwent screw fixation arthrodesis had no events of hardware complications and subsequent hardware removal. The nonunion rate was 9/65 (14%) in the tension band arthrodesis group and 2 (4%) of 45 in the screw fixation arthrodesis group. Of the thumbs that had available radiographs to assess the healing of the arthrodesis, 34 (81%) of 42 were radiographically united in the tension band arthrodesis group and 29 (91%) of 32 in the screw fixation group.