The Study On Artificial Joint Resurfacing Surgery Of Hand Joint Damage

Purpose: The hand is an important human organ of labor, and it is thelarge joints of the hand with great activity. Trauma, infection, tumor orcongenital can cause hand joint damage, and it will be seriously impact on theappearance and function of the hand, thereby affect people's daily life andwork. There are lots of methods about treatment of hand joint damage such asjoint fusion surgery,joint forming surgery, transplantation of chondrocytes, thecartilage joint forming, allogeneic or autologous joint transplantation, artificialjoint replacement surgery, but there is not yet a recognized method can beeffective to reconstruct anatomical features and structure of the joint, restorethe normal activities of the joint. With the continuous progress of the maturedevelopment of human joint replacement, artificial joint replacement in thetreatment of joint injuries of the hand has been widely used, but the artificialjoint surface of the prosthesis has not been studied. This replacement is stillblank. Based on the above reasons,the researching direction of this article isfrom the hand joint damage artificial joint surface replacement surgery toprovide some guidance and help for clinical work.Method: Using3-month-old male leghorn48, on average of1.95±0.063Kg, measure the right foot third metatarsophalangeal joint range ofmotion of each experimental animal, matching, numbered, labeled the animalswith similar or the same joint activity, and randomly divide them into A, B, C,n=16, dubbed eight pairs.Group A, eight pairs were the replacement of themetatarsophalangeal joint of the metatarsal head articulate surface and themetatarsal head articulate surface destruction of the group; group B,respectively metatarsophalangeal joint phalanx of the basal articulate surfacereplacement group and toe basal articulate surface damage group; group C,eight pairs of metatarsophalangeal joint of the metatarsal head and phalanx of the basal articulate surface replacement group and the metatarsophalangealjoint of the metatarsal head and toe basal articulate surface destruction group.In this experiment, I chose the leghorn right foot III metatarsophalangeal jointas the experimental model.Inject1%of ketamine15mg/Kg and the stability1mg/Kg in top of the Leghorn chicken thigh intramuscular, after anesthesiasatisfaction, let them supine, fix the extended right leg in the operating table,soapy water rinsed three times, followed by using2.5%of iodine,75%alcoholto disinfect right calf and foot paw skin. After draping, we do the right footthird metatarsophalangeal joint surgery.Surgical procedures: After exsanguination, use rubber band for preoperativehemostasis on the central beam of the right thigh, at the metatarsophalangealjoint dorsal made a S-shaped longitudinal incision length of3cm, cut the skinand subcutaneous tissue to expose the extensor tendon and the tendon caporganizations.Longitudinal incision dorsal extensor tendon, stripped jointcapsule from the proximal phalanx distal to retain their attention and protectboth sides of the lateral collateral ligament. Evenly scrape the surface of themetatarsal head cartilage of the eight leghorn in group A, remove themetatarsal and the thickness of it is about the thickness of the articulatesurface of the prosthesis, and then drilling1.0Kirchner wire in the middle ofthe metatarsal head, then cover metatarsal surface with joint surface of theprosthesis which has been prepared, Screw prosthesis into the medullarycavity, firmly fixed and then sutured joint capsule, and made the other8leghorn's right foot third metatarsophalangeal joint of the metatarsal articulatesurface damage as a control. Scrape the toe base joint surface cartilage of the8paired leghorn in Group B, remove the metatarsal and the thickness of it isabout the thickness of the articulate surface of the prosthesis, then covermetatarsal surface with joint surface of the prosthesis which has been prepared,firmly fixed and then sutured joint capsule, and made the other8leghorn'sright foot third metatarsophalangeal joint of the metatarsal articulate surfacedamage as a control. Scrape the toe base joint surface cartilage of the8pairedleghorn in Group c, remove the metatarsal and the thickness of it is about the thickness of the articulate surface of the prosthesis, then cover metatarsalsurface with joint surface of the prosthesis which has been prepared, firmlyfixed and then sutured joint capsule, and made the other8leghorn's right footthird metatarsophalangeal joint of the metatarsal articulate surface damage asa control. Finally split extensor tendon central beam, wash the wound, suturewounds, dressing wounds, ankle dorsifixed90°, and straightmetatarsophalangeal joints and interphalangeal joint to plaster immobilization.Gross anatomical observation:1,3weeks after surgery, randomlyselected1pairs of leghorn from A, B, and C, after the incision, executedimmediately along the original incision of the skin, subcutaneous tissue,isolated extensor tendon and joint capsule, exposed artificial joints. Used thesame method to expose each third metatarsophalangeal joint of the left side ofthe Leghorn chicken. Use the eye to observe the prosthesis surface of theorganizational change, the healing around the artificial joints, the infiltrationof surrounding tissue, adhesions, and the destruction of the joint changes andthe surrounding tissue of the joint group, the infiltration of stick training andthen compare it with normal joints and surrounding circumstances.Determination of range of motion: after replacement range of motion2,and4weeks, measure each experimental animal Sub-range of motion, andalso measure the range of motion destruction group of experimental animals,and then compare them. At last, after the fourth week of replacement jointactivity, compare it with the normal range of motion, meantime refer to Yudong Guan's Criteria of Response Evaluation on Joint activity to assess thearticulate surface replacement surgery and joint surface destruction ofpostoperative joint activities.X-ray detection: Respectively, underwent X-ray detection, before surgery,arthroplasty, and4weeks after surgery to assess the prosthesis and bonehealing, Fracture of prosthesis, loosening and bone resorption, partial bonechanges after the process on destruction of the articulate surface, joint spacenarrowing and joint activities.Result:①Gross anatomical observation:After surgery, in group7d,21d, experimental animals' subcutaneous tissue and extensor tendon tissues arecongestive, gradually edema reduced and even disappear, Inflammatoryexudate is gradually reduced, tendon loose tissue adhesion gradually reduced,there is no inflammatory reaction around the replacement articulate surface ofthe prosthesis group, a large number of granulation tissue wrapped jointprosthesis, the heal of the prosthesis surface and the articulate surface is solid,prosthesis surface is smooth, and there is no loosening and there is noloosening and abrasion; Granulation tissue around the damage joint graduallyincrease, partial adhesion increased, we can see the destruction of articulatesurface of bone, partial bone healed, the joint space gradually narrowed, rangeof motion gradually decreases.②Determination of range of motion: In groupA, B, C, compare the displacement of the articulate surface treatment withdestruction of the articulate surface treatment, the difference have significantstatistical meaning(P<0.05); In group A, B, C, compare the displacement ofthe articulate surface treatment on each time point, he difference havesignificant statistical meaning(P<0.05); In group A, B, C, compare thedisplacement of the articulate surface treatment on different position, thedifference have no significant statistical meaning(P>0.05). According to Yudong Gu's standard of effectiveness evaluation, there are23Excellent cases,1good case, average24cases, and0poor cases,1case which experimentalanimal wound is Phase Ⅱ healing, the others are Phase Ⅰ healing. Theexcellent and good experimental animals in the three groups come from theexperimental animals who have taken the displacement treatment of thearticulate surface, among them; the average experimental animals come fromthe experimental animals who have taken the treatment of destruction of thearticulate surface.③X-ray detection: the X-ray before the surgery suggeststhat the third metatarsophalangeal joint space was normal,bone didn't destruct,joint movement is normal. Compare the condition2weeks and4weeks aftersurgery, the Prosthesis and bone healing of these three group is average, Jointspace was normal, no breaking of prosthesis, no Loose and bone resorption,Joint activities got close to normal, with the extension of the healing time the three joint space of the destruction of the articulate surface, the joint spacegradually narrowed, part of the bone absorption is destructive, part of the jointwas fusion, part of the bone absorbed and turned tiny, destruction of, part ofthe arthrodesis, local bone resorption, thinning, joint activity is significantlyreduced, and Joint activity is significantly reduced.Conclusion: The artificial joint resurfacing arthroplasty is a new methodto deal with the hand joints of surface damage; this method will not onlydestroy the complete structure of the joint but also the organization of damagearound the joint. It will greatly improve the joint range of activities. There aremany reasons for joint surface cartilage wear and tear, not smoothly on jointsurface, even damage on joint surface, but the structure around the joints,ligaments, tendons, joint capsule is normal. In this case, artificial resurfacingarthroplasty is a viable treatment method. In this study, I want to provide anew way of thinking and methods for the clinical handling of joint injurypatients.