半头关节置换术治疗慢性不稳定背侧骨折脱位近端指间关节：功能和放射学结果的回顾性分析

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-04-18 DOI:10.1016/j.jcot.2025.103020

J. Terrence Jose Jerome

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引用次数: 0

摘要

本回顾性研究探讨了半头关节置换术治疗慢性不稳定背侧骨折脱位近端指间关节（PIP）的临床和影像学结果。方法本研究纳入了2020年至2022年期间因慢性不稳定PIP关节背骨折脱位接受半头关节置换术的15例患者，年龄22-36岁。13例患者有非优势手受累。临床结果通过评估PIP关节活动范围（ROM）、握力、疼痛（使用视觉模拟量表（VAS））和手臂、肩膀和手的快速残疾（QuickDASH）评分来评估。放射学评估的重点是创伤后关节炎、移植物完整性和关节稳定性。结果损伤至手术平均时间79天（45 ~ 125天），平均随访23个月（18 ~ 36个月）。在最后的随访中，平均PIP关节ROM从术前的3°显著改善到术后的95°(p <；0.05)，运动弧度在85°~ 105°之间。平均延伸延迟为2°（范围：0°-10°）。术后对侧手握力达到92%（范围：78% - 100%）。QuickDASH评分提高到平均5.5分（范围0-13.3），平均疼痛评分较低（平均VAS: 0.2，范围0-4）。根据Ishida和Ikuta评分系统，13例患者预后良好。没有患者出现术后骨关节炎、移植物塌陷、供体部位问题或手腕疼痛。3例患者有轻度伸肌迟滞（约10°），但所有患者在手术后平均13周（范围：11-16周）恢复了以前的活动。结论半头关节置换术治疗慢性不稳定PIP关节背骨折脱位具有良好的功能和影像学效果。这项技术有效地恢复了关节稳定性和大范围的活动，使患者恢复日常活动，很少出现并发症。

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Hemi-capitate arthroplasty for chronic unstable dorsal fracture-dislocations of the proximal interphalangeal joint: A retrospective analysis of functional and radiological outcomes

Background

This retrospective study examined the clinical and radiological outcomes of hemi-capitate arthroplasty in treating chronic unstable dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint.

Methods

Fifteen patients, aged 22–36 years, who underwent hemi-capitate arthroplasty for chronic unstable dorsal PIP joint fracture-dislocations between 2020 and 2022, were included in this review. Thirteen patients had nondominant hand involvement. Clinical outcomes were evaluated by assessing PIP joint range of motion (ROM), grip strength, pain using the Visual Analog Scale (VAS), and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores. Radiographic evaluations focused on posttraumatic arthritis, graft integrity, and joint stability.

Results

The average time from injury to surgery was 79 days (range: 45–125 days), with a mean follow-up of 23 months (range: 18–36 months). At the final follow-up, the mean PIP joint ROM significantly improved from 3° preoperatively to 95° postoperatively (p < 0.05), with a motion arc between 85° and 105°. The mean extension lag was 2° (range: 0°–10°). Postoperative grip strength reached 92 % (range: 78 %–100 %) of the contralateral hand. The QuickDASH score improved to a mean of 5.5 (range: 0–13.3), and mean pain score was low (mean VAS: 0.2, range: 0–4). Based on the Ishida and Ikuta scoring system, 13 patients had excellent outcomes. No patients developed postoperative osteoarthritis, graft collapse, donor-site problems, or wrist pain. Three patients had a mild extensor lag (approximately 10°), but all patients had returned to their previous activities by an average of 13 weeks (range: 11–16 weeks) after surgery.

Conclusions

Hemi-capitate arthroplasty consistently yielded positive functional and radiological outcomes in chronic unstable dorsal PIP joint fracture-dislocations. This technique effectively restores joint stability and a substantial range of motion, allowing patients to resume daily activities with few complications.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.