缝合悬吊成形术与韧带重建和肌腱植入术治疗拇指腕掌关节炎的比较

Q3 Medicine Journal of Hand Surgery Global Online Pub Date : 2024-11-01 DOI:10.1016/j.jhsg.2024.07.014

David A. Rivetti MD, MS , Maria A. Munsch MD , Jeffrey C. Wera MD , Duc M. Nguyen MD , John R. Fowler MD

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引用次数: 0

摘要

目的拇指腕掌（CMC）关节炎是最常见的手部关节炎，大多数研究表明各种手术治疗技术的疗效差异不大。然而，在美国，梯形切除术后韧带重建和肌腱插植术（LRTI）仍是手外科医生的首选技术。2009 年，缝合悬吊成形术（SS）首次被描述为 LRTI 的一种微创替代方法。本研究的目的是比较拇指 CMC 关节成形术中缝合悬吊术和 LRTI 的手术细节、患者报告结果和影像学结果。方法经机构审查委员会批准后，对 104 名接受腕掌关节成形术的患者的 111 只肢体进行了回顾性鉴定。由三位接受过研究培训的手外科医生中的一位为接受过 LRTI（n = 58）或 SS（n = 53）手术的患者建立了两个年龄匹配的队列。对止血带时间进行了比较，结果测量包括术后两周X光片上测量的第一掌骨肩胛间隙（FMSS），以及术前访视、术后2周、6周和3个月的手臂、肩部和手部快速残疾（QuickDASH）评分和10点视觉模拟量表（VAS）上的疼痛评分。两组患者在任何时间点的 VAS 评分均无统计学差异。在术后 6 周的访视中，SS 组的 QuickDASH 评分更高；除此之外，QuickDASH 评分在各组之间没有差异。SS技术的止血带时间更短，患者的放射学下沉更少，术后较大的FMSS证明了这一点。此外，SS关节置换术与LRTI相比，无需肌腱转移和额外切口，止血带时间更短，头两周内第一掌骨下陷更少。

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Suture Suspensionplasty Compared With Ligament Reconstruction and Tendon Interposition for Surgical Treatment of Thumb Carpometacarpal Arthritis

Purpose

Thumb carpometacarpal (CMC) arthritis is the most common arthritis of the hand, with most studies demonstrating little difference in outcomes between various surgical treatment techniques. However, trapeziectomy, followed by ligament reconstruction and tendon interposition (LRTI), remains the technique of choice among hand surgeons in the United States. In 2009, suture suspensionplasty (SS) was first described as a less invasive alternative to LRTI. The purpose of this study was to compare surgical details as well as patient-reported and radiographic outcomes between SS and LRTI for thumb CMC arthroplasty.

Methods

Following Institutional Review Board approval, 111 extremities were retrospectively identified in 104 patients who underwent carpometacarpal arthroplasty. Two age-matched cohorts were developed for patients having undergone LRTI (n = 58) or SS (n = 53) by one of three fellowship-trained hand surgeons. Tourniquet times were compared, and outcome measures included first metacarpal scaphoid space (FMSS) measured on 2-week postoperative radiographs, as well as Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score and pain score on a 10-point visual analog scale (VAS) from the preoperative visit as well as at 2 weeks, 6 weeks, and 3 months following surgery.

Results

There were no demographic differences between the two cohorts. There was no statistical difference between cohorts in VAS scores at any point in time. The SS cohort reported better QuickDASH scores at the 6-week postoperative visit; otherwise, QuickDASH scores did not differ between cohorts. The SS technique had shorter tourniquet times, and patients had less radiographic subsidence as evidenced by larger postoperative FMSS.

Conclusions

The SS arthroplasty technique demonstrated comparable early clinical results to LRTI. Furthermore, SS arthroplasty, which alleviates the need for tendon transfers and additional incisions with LRTI, had shorter tourniquet time, with less subsidence of the first metacarpal in the first 2 weeks.