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Outcomes after thumb carpometacarpal joint stabilization with an abductor pollicis longus tendon strip for the treatment of chronic instability.

拇指腕掌关节用拇长肌肌腱条稳定治疗慢性不稳定的结果。

  • 影响因子:2.21
  • DOI:10.1007/s00402-019-03302-8
  • 作者列表:"Stauffer A","Schwarz Y","Uranyi M","Schachinger F","Girsch W","Ganger R","Farr S
  • 发表时间:2020-02-01
Abstract

INTRODUCTION:Instabilities of the thumb carpometacarpal (CMC) joint, caused by idiopathic ligamentous hyperlaxity, trauma or other conditions may lead to pain, functional impairment and eventually osteoarthritis. Several techniques have been described to enhance stability of the CMC 1. The aim of this study was to evaluate postoperative outcomes after CMC 1 joint stabilization using a soft-tissue procedure in patients with chronic instability. MATERIALS AND METHODS:This study was designed as a retrospective study with a single follow-up visit after a minimum of 1 year postoperatively. All patients who underwent stabilization of the CMC 1 with an abductor pollicis longus (APL) tendon strip for chronic, habitual instability were re-assessed using clinical examination, dedicated outcome scores [Visual Analogue Scale (VAS); The Disability of the Arm, Shoulder and Hand (DASH) score; Nelson score; Kapandji opposition score], grip and pinch strength measurements, and radiographic examination. RESULTS:12 patients (15 operated thumbs) with a mean age at surgery of 23.2 (± 9.3) years were included after a mean follow-up period of 3.5 (± 1.3) years. The postoperative outcomes indicated excellent results, with a mean DASH score of 13.3 (± 11.3), VAS 1.1 at rest (and 2.8 during stress) and Nelson score of 87.7 (± 11.3). Postoperative grip, pinch strength and passive stability were not significantly different between operated and non-operated sides (p = 0.852; p = 0.923 and p = 0.428, respectively). We observed one case of recurrent instability besides no other complications. However, patients with trapezium hypoplasia (5 of 12) were more prone to signs of radiographic instability during stress testing. CONCLUSIONS:Thumb carpometacarpal stabilization with an APL tendon strip yielded excellent clinical outcomes and low morbidity in the mid-term. However, long-term follow-up is needed to assess specifically whether patients with trapezium hypoplasia may be more prone to clinical symptom recurrence than those with normal anatomy. LEVEL OF EVIDENCE:Level IV.

摘要

简介: 特发性韧带过度松弛、创伤或其他情况引起的拇指腕掌 (CMC) 关节的不稳定性可能导致疼痛、功能障碍并最终导致骨关节炎。已经描述了几种增强CMC 1 稳定性的技术。本研究的目的是评估慢性不稳定患者使用软组织手术进行CMC 1 关节稳定后的术后结果。 材料和方法: 本研究设计为回顾性研究,术后至少 1 年进行单次随访。所有因慢性习惯性不稳定用拇长肌 (APL) 肌腱条稳定CMC 1 的患者均使用临床检查重新评估。专用结局评分 [视觉模拟量表 (VAS); 臂、肩、手残疾 (DASH) 评分; Nelson评分;Kapandji反对分数] 、握力和捏力测量以及影像学检查。 结果: 在平均 23.2 (± 9.3) 个随访期后,纳入 12 例平均年龄为 3.5 (± 1.3) 年的患者 (15 个手术拇指)。几年了。术后结果表明结果良好,平均DASH评分为 13.3 (± 11.3),静息时VAS为 1.1 (应激时 2.8) 和Nelson评分 87.7 (± 11.3)。手术侧和非手术侧术后握力、捏力和被动稳定性无显著差异 (p = 0.852; P = 0.923 和p = 0.428)。我们观察到 1 例复发性不稳定,无其他并发症。然而,梯形发育不全的患者 (12 例中的 5 例) 在压力测试过程中更容易出现影像学不稳定的迹象。 结论: 使用APL肌腱条的拇指腕掌稳定术产生了极好的临床结果,中期发病率低。然而,需要长期随访,以具体评估梯形发育不全的患者是否可能比解剖正常的患者更容易出现临床症状复发。 证据级别: IV级。

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影响因子:4.13
发表时间:2020-01-01
DOI:10.1002/acr.23824
作者列表:["Chen SK","Liao KP","Liu J","Kim SC"]

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