拇指基底关节置换术失败：导致再手术的常见原因分析

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-03-01 DOI:10.1016/j.jhsg.2024.12.004

Adina Harri BA , Emily J. Harman MD , Jennifer Chickering OTR/L, CHT , Lance G. Warhold MD , Vincent D. Pellegrini Jr MD

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引用次数: 0

摘要

目的手部骨关节炎是导致功能障碍的重要原因，而基底关节是最常见的手术治疗部位。手术方法的选择很大程度上取决于外科医生的偏好，原发性基底关节置换术失败的原因和翻修的流行程度尚不明确。我们试图了解翻修基底关节手术的病因。方法回顾性分析2014年至2022年2名资深手外科医生对23例骨关节炎患者行原发性基底关节置换术后的26例24根拇指再手术。图表回顾获得了人口统计学和历史信息、手术技术和翻修程序、表现症状、再手术时间和术中翻修结果。影像学检查包括预矫正拇指掌骨下沉、桡骨半脱位、舟状骨撞击和未经治疗的舟状骨关节炎。结果所有患者在就诊时主要表现为疼痛，其次是功能受损（n = 11）和拇指背侧感觉障碍（n = 2）。物理表现包括掌指关节过伸（n = 12）、拇指轴向不稳（n = 10）和手掌无法平放（n = 5）；后者发生在7个拇指中的4个，其中4个进行了食指钢丝绳或旋转锁定手术，1个拇指进行了韧带重建和肌腱插入旋转锁定装置。6例患者（25.0%）有“其他”病理，包括腕管综合征、可触及的异物、头状半脱位和EPL功能缺失。x线片显示未经治疗的舟状寰椎关节炎（18）、桡骨掌骨基部半脱位（18）、拇指近端掌骨移位（17）和寰椎间隙高度；5毫米（16）。术中翻修发现包括拇指近端掌骨移位（12），未经治疗的舟状骨关节炎(9)，异物肉芽肿(6)，掌指关节过伸(5)，撞击性骨赘(4)，舟状骨-掌骨撞击(3)，缝合锚拔出(2)。结论翻修基底关节置换术中最常见的病理包括：舟状骨不稳定，未识别的舟状骨关节炎，未经治疗的掌指关节过伸。功能障碍是由于医源性无法使手掌变平而导致的，这与使用旋转锁和钢丝绳锚定装置来稳定拇指掌骨有关。研究类型/证据水平鉴别诊断/症状患病率研究IV。

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Failed Thumb Basal Joint Arthroplasty: An Analysis of Common Etiologies Leading to Reoperation

Purpose

Hand osteoarthritis contributes considerably to functional disability, and the basal joint is the most common site treated surgically. Procedure choice is largely based on surgeon preference, and causes of primary basal joint arthroplasty failure and prevalence of revision are poorly defined. We seek to understand the etiologies of revision basal joint surgery.

Methods

Retrospective medical record review identified 26 reoperations in 24 thumbs in 23 patients by two senior hand surgeons following primary basal joint arthroplasty performed for osteoarthritis from 2014 to 2022. Chart review yielded demographic and historical information, surgical technique of index and revision procedures, presenting symptoms, time to reoperation, and intraoperative revision findings. Radiographic measures included prerevision thumb metacarpal subsidence, radial subluxation, scaphoid impingement, and untreated scaphotrapezoid arthritis.

Results

All patients complained primarily of pain on presentation, followed by impaired function (n = 11) and dorsal thumb dysesthesias (n = 2). Physical findings included metacarpophalangeal joint hyperextension (n = 12), axial thumb instability (n = 10), and inability to flatten the palm (n = 5); the latter occurred in four of seven thumbs having index TightRope or swivel-lock procedures and one thumb having ligament reconstruction and tendon interposition with a swivel-lock device. Six patients (25.0%) had “other” pathologies including carpal tunnel syndrome, palpable foreign body, capitate subluxation, and absent EPL function. Radiographs revealed untreated scaphotrapezoid arthritis (18), radial metacarpal base subluxation (18), proximal thumb metacarpal migration (17), and trapezial space height < 5 mm (16). Intraoperative revision findings included proximal thumb metacarpal migration (12), untreated scaphotrapezoid arthritis (9), foreign body granuloma (6), metacarpophalangeal joint hyperextension (5), impinging osteophytes (4), scaphoid-metacarpal impingement (3), and suture anchor pull-out (2).

Conclusions

The most common pathologies encountered during revision basal joint arthroplasty include trapeziometacarpal instability, unrecognized scaphotrapezoid arthritis, and untreated metacarpophalangeal joint hyperextension. Dysfunction resulted from iatrogenic inability to flatten the palm associated with use of swivel-lock and TightRope anchor devices to stabilize the thumb metacarpal.