抄録
Objective: In this study, we reviewed and compared our surgical results of implant arthroplasty (IA) and trapeziometacarpal arthrodesis (AD).
Methods: A retrospective review was undertaken of IA and AD cases, that were performed between 2000 and 2007. There were 10 cases who were actively followed up for over 5 years in our hospital. Pre- and postoperative clinical and radiographic data were reviewed. The average age of the IA group was 70.5 years and that of the AD group was 65.5 years. The average follow-up term was 94.9 months for the IA group and 88.8 months for the AD group. According to Eaton's radiographic evaluation, there were 3 grade II cases, 6 grade III cases, and 1 grade IV case in the IA group. There were 5 grade II and grade III cases respectively in the AD group. All IA group patients underwent joint replacement with Avanta (Small Bone Innovations, USA), and among the AD group, fixation with tension band wiring was used for 5 cases and screws (Acutrak, Kobayashi Medical, Japan) for the remaining 5 cases. The items evaluated included Eaton's clinical criteria (without joint instability), radiographic changes, key pinch and complications.
Results: No statistically significant differences between the two groups were found for key pinch improvement and Eaton's clinical criteria. In the IA group, there was no scaphotrapeziotrapezoid (STT) or metacarpophalangeal (MP) joint arthritis. However, there were 2 cases of loosening or sinking of the implant and such patients had occasional pain. In the AD group, radiographic progression of STT joint arthritis occurred in 3 patient thumbs, but only 1 patient was symptomatic. There were no cases of MP joint arthritis. There were 2 nonunions and one patient complained of pain.
Conclusions: For most patients, implant arthroplasty or arthrodesis reduced pain and improved function. Although implant loosening or sinking was identified in some cases in the IA group, there was no development of STT or MP joint arthritis and all patients maintained adequate range of motion of the thumb. IA appeared to be a better method than AD for individually selected patients.
