拇指掌指关节融合术会增加掌斜骨负荷吗？

IF 0.9 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation Pub Date : 2025-04-01 DOI:10.1016/j.hansur.2025.102110

Pascal Ledoux

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引用次数: 0

摘要

作者简介：JY de la caffini正式禁止将拇指斜骨掌骨假体和掌骨指关节融合术联合应用。这是一个具有里程碑意义的概念，但没有理论、实验或临床研究证实它。关节融合术和斜骨腕关节假体的联合适应症是罕见的。孤立性关节融合术更为常见。在这两种情况下，重要的是要避免过度负荷的梯形腕关节。目的：本研究的目的是验证掌指关节融合术在考虑骨缩短和关节融合术角度的情况下，是否确实增加了斜跖关节的负荷。第二个目的是回顾一系列的文献掌指关节拇指关节病。材料和方法：我们使用了先前开发的二维数学模型来计算在关键捏握时梯形腕关节的应力。我们计算了恒定拇指柱长度下的应力，以及缩短6和8毫米后的应力，以考虑进行关节融合术所需的骨切除。我们还测试了关节融合术中掌骨和第一指骨之间的屈曲程度。结果：在所有其他参数相同的情况下，我们发现掌指关节融合术后，掌方应力增加了118%。在屈曲25°处进行关节融合术时，梯形掌骨应力水平与生理情况相当。结论：关节融合术在屈曲25°时不会增加斜跖骨应力。在这些情况下，掌指关节融合术不会增加患斜骨手骨关节炎的风险，并且与斜骨手骨假体兼容。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Does thumb metacarpophalangeal arthrodesis increase trapeziometacarpal loading?

Introduction

The combination of a trapeziometacarpal prosthesis and a metacarpophalangeal arthrodesis of the thumb was formally contraindicated by JY de la Caffinière. This is a landmark notion, but no theoretical, experimental or clinical study has confirmed it. Combined indications for arthrodesis and trapeziometacarpal prosthesis are rare. Isolated arthrodesis is more common. In both cases, it is important to avoid overloading the trapeziometacarpal joint.

Aim

The aim of this study is to verify whether metacarpophalangeal arthrodesis really does increase the load on the trapeziometacarpal joint, taking into account bone shortening and the angle at which the arthrodesis is performed. The second aim is to review the literature on series of metacarpophalangeal thumb arthrodeses.

Material & Methods: We used a previously developed 2-dimensional mathematical model to calculate stresses at the trapeziometacarpal joint during a key pinch grip. We calculated stresses at constant thumb column lenght, and after 6 and 8 mm shortening to account for the bone resection required to perform arthrodesis. We also tested several levels of flexion between the metacarpal and the first phalanx in the arthrodesis situation.

Results

All other parameters being equal, we found a 118% increase in trapeziometacarpal stress after metacarpophalangeal arthrodesis. When arthrodesis is performed at 25 ° of flexion, the trapeziometacarpal stress level is comparable to the physiological situation.

Conclusions

Arthrodesis does not increase trapeziometacarpal stress when performed at 25 ° flexion. Under these conditions, metacarpophalangeal arthrodesis does not increase the risk of trapeziometacarpal osteoarthritis, and is compatible with a trapeziometacarpal prosthesis.

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来源期刊

Hand Surgery & Rehabilitation Medicine-Surgery

CiteScore

1.70

自引率

27.30%

发文量

审稿时长

49 days

期刊介绍： As the official publication of the French, Belgian and Swiss Societies for Surgery of the Hand, as well as of the French Society of Rehabilitation of the Hand & Upper Limb, ''Hand Surgery and Rehabilitation'' - formerly named "Chirurgie de la Main" - publishes original articles, literature reviews, technical notes, and clinical cases. It is indexed in the main international databases (including Medline). Initially a platform for French-speaking hand surgeons, the journal will now publish its articles in English to disseminate its author''s scientific findings more widely. The journal also includes a biannual supplement in French, the monograph of the French Society for Surgery of the Hand, where comprehensive reviews in the fields of hand, peripheral nerve and upper limb surgery are presented. Organe officiel de la Société française de chirurgie de la main, de la Société française de Rééducation de la main (SFRM-GEMMSOR), de la Société suisse de chirurgie de la main et du Belgian Hand Group, indexée dans les grandes bases de données internationales (Medline, Embase, Pascal, Scopus), Hand Surgery and Rehabilitation - anciennement titrée Chirurgie de la main - publie des articles originaux, des revues de la littérature, des notes techniques, des cas clinique. Initialement plateforme d''expression francophone de la spécialité, la revue s''oriente désormais vers l''anglais pour devenir une référence scientifique et de formation de la spécialité en France et en Europe. Avec 6 publications en anglais par an, la revue comprend également un supplément biannuel, la monographie du GEM, où sont présentées en français, des mises au point complètes dans les domaines de la chirurgie de la main, des nerfs périphériques et du membre supérieur.