指骨关节炎的医学创新和外科治疗

Adeline Cambon-Binder , Alice Courties
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引用次数: 0

摘要

手骨关节炎(OA)是一种非常常见和异质性的疾病。其医疗管理目前基于欧洲的建议,包括药理学(局部非甾体抗炎药和渗透)和非药理学措施(矫形术和人体工程学)。用于类风湿关节炎的常规合成或生物治疗尚未显示出任何疗效。近年来唯一的阳性试验是低剂量皮质类固醇治疗,它已证明有暂停作用。然而,新的治疗选择,如肉毒杆菌毒素浸润或迷走神经刺激目前正在评估。就手术治疗而言,关节融合术仍然是远端指间骨关节炎的首选干预措施,新的固定方法可以立即活动。在近端指间水平,关节去神经支配是一种有趣的保守解决方案,而使用假体可以获得最佳的功能效果。新模型的表面置换植入物比铰链硅胶植入物具有更高的振幅,但我们还没有对后者进行后见之明。对于拇指基础骨关节炎,近年来,带或不带悬韧带成形术的斜方切除术面临着来自斜方手骨假体的激烈竞争,尽管斜方手骨假体的并发症发生率较高,但其功能恢复速度更快,长期生存率尚不清楚。总的来说,手术决策是基于多种因素:患者的功能需求,骨关节炎关节的稳定性,影像学解剖参数。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Nouveautés médicales et prise en charge chirurgicale dans l’arthrose digitale

Hand osteoarthritis (OA) is a very frequent and heterogeneous disease. Its medical management is currently based on European recommendations and includes pharmacological (topical NSAIDs, and infiltrations) and non-pharmacological measures (orthotics, and ergonomics). Conventional synthetic or biological treatments used in rheumatoid arthritis have not demonstrated any efficacy. The only positive trial in recent years is low-dose corticosteroid therapy, which has demonstrated a suspensive effect. However, new therapeutic options such as botulinum toxin infiltrations or vagus nerve stimulation are currently being evaluated. As far as surgical treatment is concerned, arthrodesis remains the intervention of choice for distal interphalangeal OA and new fixation methods allow immediate mobilization. At the proximal interphalangeal level, joint denervation is an interesting conservative solution, while the best functional result is obtained with a prosthesis. The new models of resurfacing implants give higher amplitudes than hinged silicone implants, but we do not yet have the hindsight we have for the latter. For thumb base OA, trapezectomy with or without suspension ligamentoplasty has been confronted in recent years with severe competition from trapeziometacarpal prostheses, which allow faster functional recovery despite a higher complication rate and a long-term survival that is still poorly known. In total, surgical decision-making is based on multiple factors: functional demand of the patient, stability of the osteoarthritic joint, radiographic anatomical parameters.

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