原著
関節リウマチに対するMCP関節人工関節置換術中に手関節部での腱剥離術を要した症例の検討
2019 年 38 巻 4 号 p. 471-477
詳細
2019 年 38 巻 4 号 p. 471-477
Objective: The aim of this study was to investigate characteristics of patients who required additional extensor tenolysis at the wrist level during metacarpophalangeal (MCP) joint arthroplasty for rheumatoid arthritis.
Patients and Methods: 255 fingers (excluding thumbs) of 72 hands in 57 patients who underwent silastic arthroplasty for MCP joints using AVANTA® from 2009 to 2017 were included in the retrospective study. The mean age was 61.8±11.9 years, and the duration of disease was 25.2±17.2 years at the time of surgery. We investigated the number of patients who required extensor tenolysis at the wrist. Then, the relationship between the presence of tenolysis (tenolysis (+) group / tenolysis (−) group) and the history of wrist surgery was analyzed. We also compared the clinical results between the two groups with regard to pre- and postoperative range of motion (ROM) of the MCP joint, HAND 20 and DASH.
Results: In 12 hands (16.7%), additional extensor tenolysis at the wrist was required. Of 15 hands with previous wrist surgeries, extensor tendon adhesion at the wrist level occurred in six of them. The rate of cases which required extensor tenolysis was significantly higher in cases with a history of wrist surgery (P<0.01). ROM of MCP joints significantly improved irrespective of the presence of extensor tendon adhesion after MCP joint arthroplasty (P＜0.01). There were no significant differences in the improvement of ROM of MCP joints, HAND 20, and DASH between the tenolysis (+) group and the tenolysis (−) group, respectively. (P＜0.05).
Conclusion: In cases with a history of wrist surgery, extensor tenolysis at the wrist joint was required more frequently (40%). In RA cases with volar dislocation or subdislocation of the MCP joint, preoperative diagnosis of extensor tendon adhesion at wrist joint is often difficult to predict. However, the results of the current study showed that equivalent results were obtained after MCP joint arthroplasty by additional extensor tenolysis.
