母指CM関節症に対するThompson法の骨孔位置の検討

抄録

Objective: It is important to examine the bone tunnel position for the reconstructed ligament in arthroplasty for thumb carpometacarpal joint osteoarthritis (TCJO), in determining the direction for stabilizing the digit. However, there has been little research on the bone tunnel position of arthroplasty. We aimed to evaluate the biomechanical efficacy of the placement of the bone tunnel position for the reconstructed ligament in arthroplasty using the Thompson technique for TCJO.

Methods: Sixteen patients (twenty hands) with TCJO who underwent arthroplasty using the Thompson technique were examined. Based on the report of Nanno et al., for physiological ligament reconstruction, the first metacarpal bone tunnel was made from the dorsoradial ligament attachment toward the radiodorsal side of the joint surface center. The second metacarpal bone tunnel was made from the attachment of the volar intermetacarpal ligament toward the ulnodorsal side of the second metacarpal.

Results: Complete pain relief was obtained, and thumb radial and volar abduction, grip strength, pinching force, and QuickDASH were improved in all patients after arthroplasty.

Conclusion: In recent years, promising results from many arthroplasties for TCJO have been described. However, there are some reports finding no significant differences in the range of motion of thumb abduction before and after arthroplasty. In the current study, we assumed that the bone tunnel position affects the differences in improvement of thumb abduction after arthroplasty. Additionally, we examined the relationship between the bone tunnel position and thumb abduction. Consequently, thumb radial and volar abduction were improved by placement of the bone tunnel position, and promising results were obtained. This finding suggests that it is effective to evaluate the bone tunnel position in arthroplasty for TCJO to improve thumb abduction.