首页> 美国卫生研究院文献>Journal of Hand and Microsurgery >Correction of a Hyperextension Deformity at the Metacarpophalangeal Joint by Arthroplasty for Osteoarthritis of the Thumb Carpometacarpal Joint Followed by External Fixator: A Case Series
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Correction of a Hyperextension Deformity at the Metacarpophalangeal Joint by Arthroplasty for Osteoarthritis of the Thumb Carpometacarpal Joint Followed by External Fixator: A Case Series

机译:人工关节置换术治疗拇指掌指关节骨关节炎然后外固定架矫正掌指关节过度伸展畸形:病例系列

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摘要

A hyperextension deformity in the advanced stages of carpometacarpal (CMC) arthritis of the thumb could affect the outcomes of thumb CMC joint arthroplasty. We introduce the interesting approach for treating severely collapsed thumb deformities with gradual distraction and coordinated correction of the MCP and CMC joints by means of external fixators. We divided 8 cases into 3 groups according to the angle of passive flexion of the hyperextended MCP joint: group 1, 10–20°, group 2a, 20–40°, and group 2b, >40°, retrospectively. We first performed CMC arthroplasty with trapezium excision. In group 1, we corrected the MCP hyperextension deformity by manual passive flexion and fixed the joint with an extension block Kirshner wire (K-wire) for 2 months. However, deformities recurred in 2 of 5 cases after removing the K-wire. These patients received corrective percutaneous osteotomy with external fixators at the metacarpal neck. In groups 2a and 2b, we performed CMC arthroplasty and set external fixators at the same time. All cases in groups 1 and 2a have been without recurrence for more than 2 years, while a deformity recurred in group 2b. The results of this small case series encouraged us to propose an interesting approach for collapsed zigzag thumb deformity. Good outcomes with excellent maintenance of active MCP movement and no recurrence are highly anticipated if the hyperextended thumb has no obvious degenerative changes and can be corrected by <40° of passive flexion. Our results also indicate a risk of recurrence associated with extension block by K-wire.
机译:拇指腕掌(CMC)关节炎晚期的过度伸展畸形可能会影响拇指CMC关节置换术的结果。我们介绍了一种有趣的方法,可以逐渐分散注意力,并借助外部固定器对MCP和CMC关节进行联合矫正,以治疗严重塌陷的拇指畸形。根据超伸MCP关节被动屈曲的角度,我们将8例分为3组:分别是第1、10–20°组,2a,20–40°组和第2b组,> 40°。我们首先采用梯形切除术进行CMC关节置换术。在第1组中,我们通过手动被动屈曲矫正了MCP过度伸展畸形,并用科克纳延长线(K-wire)固定了关节2个月。但是,在移除K线后,有5例中有2例再次出现畸形。这些患者在掌骨颈部接受了外固定架的经皮经皮截骨术。在第2a和2b组中,我们进行了CMC关节置换术,并同时设置了外部固定器。第1组和第2a组的所有病例都没有复发超过2年,而第2b组的畸形复发了。这个小病例系列的结果鼓励我们提出一种解决曲折拇指畸形的有趣方法。如果过度伸展的拇指没有明显的退行性改变并且可以通过<40°的被动屈曲进行矫正,则可以很好地预见到良好的结果,可以很好地保持主动MCP运动并没有复发。我们的结果还表明与K-wire延长阻滞有关的复发风险。

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