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首页> 外文期刊>Journal of Hand Surgery. American Volume >Addition-Subtraction Osteotomy With Ligamentoplasty for Symptomatic Trapezial Dysplasia With Metacarpal Instability: A 10-Year Follow-Up
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Addition-Subtraction Osteotomy With Ligamentoplasty for Symptomatic Trapezial Dysplasia With Metacarpal Instability: A 10-Year Follow-Up

机译：韧带成形术添加到症状性血管翻透术的添加 - 具有梅曲术不稳定的韧带成形术：10年的随访

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Purpose Symptomatic trapezial dysplasia with metacarpal instability in a nonarthritic joint can lead to a disabling condition characterized by decreased pain, mobility, and strength. Bony correction may be required in dysplastic joints, because soft tissue correction might be insufficient to stabilize the trapeziometacarpal (TMC) joint. We combined 2 techniques described previously, an abductionextension osteotomy of the first metacarpal and an opening wedge osteotomy of the trapezium, including a ligament reconstruction (hemi-flexor carpi radialis). The aim of this study was to investigate the long-term results of this technique. Methods In this single-center, retrospective cohort study, we included patients treated surgically for primary instability of the TMC joint with trapezial dysplasia between 2003 and 2007. We measured pain (visual analog scale), mobility (opposition and retropulsion), patient-reported disability (QuickeDisabilities of the Arm, Shoulder, and Hand), and radiographic evaluation (Devers' angle) 10 years after surgery. Results were compared with preoperative data. Results We reviewed 17 thumbs retrospectively (mean follow-up, 12 years). One patient was converted to a TMC prosthesis. Key pinch improved significantly from 5.2 kg (+/- 2.4 kg) at baseline to 6.3 kg (+/- 2.1 kg) at 10-year follow-up. QuickeDisabilities of the Arm, Shoulder, and Hand score and Devers' angle were significantly better after 10 years compared with preoperative data. There was a mean visual analog scale score of 0.5 (+/- 1.4) at rest and 2.3 (+/- 2.6) during activities. Ten years after surgery, 5 patients had a stable Eaton score of 1. Four patients had progression to stage 2, and 5 to stage 3. Conclusions Additionesubtraction osteotomy with ligamentoplasty has a positive long-term effect on symptomatic trapezial dysplasia with TMC joint instability. Although this operation did not protect the TMC joint from further wear, pain was acceptable for most patients. Copyright (C) 2021 by the American Society for Surgery of the Hand. All rights reserved.)
机译：目的症状性斜方肌发育不良伴掌骨不稳定的非关节炎可导致以疼痛、活动度和力量降低为特征的致残状态。发育不良的关节可能需要进行骨性矫正，因为软组织矫正可能不足以稳定斜方中间腕关节（TMC）。我们结合了前面描述的两种技术，第一掌骨外展伸展截骨术和斜方骨开放楔形截骨术，包括韧带重建（桡侧腕半屈肌）。本研究的目的是调查这项技术的长期效果。方法在这项单中心回顾性队列研究中，我们纳入了2003年至2007年间因原发性颞下颌关节不稳定伴斜方肌发育不良而接受手术治疗的患者。术后10年，我们测量了疼痛（视觉模拟量表）、活动度（对向和反搏）、患者报告的残疾（手臂、肩膀和手的快速稳定性）和放射学评估（德弗斯角）。结果与术前数据进行比较。结果我们回顾性分析了17个拇指（平均随访12年）。一名患者被转换为TMC假体。在10年的随访中，关键捏压从基线检查时的5.2千克（+/-2.4千克）显著改善到6.3千克（+/-2.1千克）。10年后，与术前数据相比，手臂、肩膀和手的快速稳定性评分和德弗斯角显著改善。休息时的平均视觉模拟量表得分为0.5（+/-1.4），活动时的平均视觉模拟量表得分为2.3（+/-2.6）。术后10年，5名患者的Eaton评分稳定在1分。4名患者进展至2期，5名进展至3期。结论附加牵引截骨术加韧带成形术对伴有TMC关节不稳定的症状性斜方肌发育不良具有积极的长期疗效。虽然该手术不能保护TMC关节免受进一步磨损，但疼痛对大多数患者来说是可以接受的。版权所有（C）2021美国外科学会的手。版权所有。）

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