系统性硬化症患者关节融合术的预后

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-01-01 DOI:10.1016/j.jhsg.2024.06.015

Melanie Bertolino BS , Kyra A. Benavent BS , Zachary Li BS , Dafang Zhang MD , Philip E. Blazar MD , Brandon E. Earp MD

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引用次数: 0

摘要

系统性硬化症（硬皮病）是一种慢性自身免疫性结缔组织疾病，可导致显着的疼痛和手指功能限制。本研究评估硬皮病患者指间关节融合术后的并发症和再手术。方法回顾性分析2006年9月1日至2019年12月31日期间，在由两个一级创伤中心和两个社区教学医院组成的综合卫生系统中，所有接受指关节近端（PIP）、指关节远端或拇指指关节融合术的患者。6例接受13个IP关节融合术的患者被纳入研究。从医疗记录中收集患者人口统计资料、合并症、手术信息和术后结果。结果6例患者13根手指均行指关节融合术。弥漫性硬皮病3例，女性4例。大多数手术采用克氏针在PIP关节上进行（13例中有9例）。无患者出现术中并发症。3例患者出现术后并发症，包括屈曲畸形、不适和蜂窝织炎。在原发性关节融合术患者中，9个关节中有2个不愈合。一名患者因PIP关节置换术失败而接受了4个PIP关节的关节融合术，结果4个手指都不愈合。在出现并发症和骨不连的患者中，3例需要再次手术。结论我们的研究表明，关节融合术是硬皮病继发关节畸形患者可接受的治疗选择；然而，外科医生和患者应该意识到并发症的高发生率。研究类型/证据水平：治疗性

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Outcomes of Joint Arthrodesis in Patients With Systemic Sclerosis

Purpose

Systemic sclerosis (scleroderma) is a chronic autoimmune connective tissue disorder that can lead to notable pain and functional limitations of the digits. This study assessed complications and reoperations after interphalangeal (IP) joint arthrodesis in patients with scleroderma.

Methods

A retrospective review was performed of all patients who underwent digital joint arthrodesis of the proximal IP (PIP), distal IP, or thumb IP joints between September 1, 2006, and December 31, 2019, at an integrated health system comprising two level-I trauma centers and two community teaching hospitals. Six patients who underwent arthrodesis of 13 IP joints were included in the study. Patient demographics, comorbidities, surgical information, and postoperative outcomes were collected from the medical record.

Results

Thirteen digits in six patients were treated with digital joint arthrodesis. Three patients had diffuse scleroderma, and four patients were women. The majority of procedures were performed on the PIP joint with Kirshner wires (nine of 13). No patients experienced intraoperative complications. Three patients experienced postoperative complications including flexion deformity, discomfort, and cellulitis. In patients who had primary arthrodesis, two of nine joints went on to nonunion. One patient who underwent arthrodesis of four PIP joints for failed PIP arthroplasties went on to nonunion of all four digits. Of the patients with complications and nonunion, three required reoperation.

Conclusions

Our study suggests that arthrodesis is an acceptable treatment option for patients with joint deformities secondary to scleroderma; however, surgeons and patients should be aware of higher rates of complications.