| Objective: With the continuous development of the national economyand the improvement of people’s living standard, more and more attention ispaid to the impact that the first carpometacarpal joint osteoarthritis has on thefunction of human hands. The first carpometacarpal joint is a saddle jointwhere the thumb can flex about45°, dorsally extend about5°, adduct about5°,abduct about40°. Based on this fact, the first carpometacarpal joint can dovarious flexible actions to meet the daily needs of people’s life. And as themost active joint among all the joints of human hand, if being destroyed byosteoarthritis on this saddle joint’s articular surface, it will not only bring painand discomfort to patients, but also can cause hand dysfunction which willreduce the quality of life, so the early treatment for the first carpometacarpaljoint osteoarthritis will mainly focus on conservative treatment, includingresting, symptomatic treatment with a physical therapy combined withnon-steroidal analgesics. In case the conservative treatment does not work,surgery will be adopted then, the main purpose of which is to relieve pain,prevent further growth of the disease, improve the range of motion of the firstcarpometacarpal joint, enhance the thumb grip and pinch strength, and finally,improve the quality of life of the patients. The first carpometacarpal jointosteoarthritis treatment experienced stages of denervation therapy, joint fusionfixation, prosthetic replacement, and ligament reconstruction arthroplasty. Inrecent years, there are also some reports about arthroscopic treatment of thefirst carpometacarpal joint osteoarthritis both at home and abroad. Varioussurgical methods have their own pros and cons, however, the current domesticand international mainstream view is that the ligament reconstructionarthroplasty has a good effect in both relieving pain and improving the rangeof motion of the thumb. Additionally, for the materials selection of the ligament in the reconstruction, flexor carpi radialis, abductor pollicis longus,and extensor carpi radialis longus are most often used ones. This thesis has acomparison between the long term clinical efficacy of trapezium boneremoval arthroplasty of carpometacarpal joint for the first carpometacarpaljoint osteoarthritis and the arthroplasty of reconstruction of the suspensoryligament using uniform standards, for the purpose of providing a simple andeffective surgical method for the clinical treatment of the first carpometaca-rpal joint osteoarthritis.Methods: There are10patients of the first carpometacarpal jointosteoarthritis phase II and higher in our hospital from Jan.2010to Mar.2014,and10surgical cases, among whom the oldest is of67years old and theyoungest41years old, with an average of56years old. Also, among themthere are4males and6females;6left-hand cases,4right-hand cases;7casesof manual workers,1case of a driver,1case of literary and art worker, and1case of office worker. The course of the disease of these patients are all morethan2years, and all of these patients received resting and conservativetreatment of at least eight months, however, the effect is not ideal。Among allthe patients,11cases received the first carpometacarpal arthroplasty.Postoperative follow-up is taken on all the cases, with a minimum period of6months, the longest period of45months, and an average period of18.5months. The follow-up results are showed in the form of evaluation of thepain and the range of motion of the joint. We also take postoperativefollow-up on the grip strength, key-pinch strength, and the determination ofthe distance between X-ray A-P positions of the first metacarpal bone base–far articular surface of the navicular bone. Comprehensive evaluation of thedegree of functional recovery of the first carpometacarpal joint is taken underthe reference from many related literatures, and a uniform grading standard, inwhich way the pain and range of motion of the joint is rated. Data results likegrip strength and key-pinch strength are analyzed under the same gradingstandard with other ligament reconstruction arthroplasty in order to do ahorizontal comparison for the excellent rates of various operative methods, and in this way, to determine the effect of the operation of trapezium boneremoval arthroplasty of carpometacarpal joint, and to provide a basis forchoosing the clinical treatment methods.Results: Compared with the treatment outcomes of suspension splingarthroplasty of the first trapeziometacarpal joint with flexor carpal radialistendon to stabilize the base of the first metacarpal after trapezium removal inpatients who have suffered osteoarthritis of the first trapeziometacarpaljoint,the medical index of evaluate the function of hand include gripstrength,key-pinch,visual analogue scales(VAS) and Kapandji score.X-rayswere taken6months after the surgery to measure the distance between thefirst metacarpal base and distal scaphoid aiticular surface.The representationof visual analogue scales(VAS) was:0means no pain and10means intolerablepain, Kapandji score was representated by the location fou the thumb tip canreach,1means sections of the radial side of the index finger,2means seactionsof the radial side of the index finger distal,3means sections of the index fingertip,4means sections of middle finger tip,5means sections of the ring fingertip,6means sections of the pinky tip,7means the sections of pinky fingerdistal transverse lines,8means the sections of pinky finger proximaltransverse lines,9means the sections of pinky finger metacarpophalangealjoint cross pattern.10means the sections of far palm cross pattern.The control group was followed-up an average of15months,rangingfrom12to26months,postoperative VAS of pain decreased from7.0to1.6.Grip strength increased from11to22kg, while key pinch increased from1.8to3.4kg. Kapandji Score increased from6.0to8.7.The average spacebetween the first metacarpal base and distal scaphoid articular surface was8.8mm on A-P view X-ray.While the experimental group was followed-up anaverage of18.5months, ranging from6to45months,,postoperative VAS ofpain decreased from6.5to1.4.Grip strength increased from10.6to22.2kg,while key pinch increased from1.6to3.1kg. Kapandji Score increased from5.5to8.5.The average space between the first metacarpal base and distalscaphoid articular surface was6.8mm on A-P view X-ray. On the basis of outcome long term follow-up,compared with suspension spling arthroplasty ofthe first trapeziometacarpal joint with flexor carpal radialis tendon to stabilizethe base of the first metacarpal after trapezium which have recognited byoutside the mainstream view, wo use trapezium bone removal arthroplasty ofcarpometacarpal joint for the first carpometacarpal joint osteoarthritis in thefirst carpometacarpal joint osteoarthritis treatment, the function of handimproved significantly, the decreasing of pain is most significant, grip strengthand key pinch got different degrees of improvement. The increasing ofKapandji Score of experimental group showed the functional improvement ofthumb. Analyze the data by SPSS13.0statistical software and dealt withvariance analysis and t-test within groups,so that wo can evaluat the effect oftrapezium bone removal arthroplasty of carpometacarpal joint for the firstcarpometacarpal joint osteoarthritis.Conclusion: There was significant difference in medical index ofevaluate the function of hand between2groups (P＞0.05)，so when we treatthe first carpometacarpal joint osteoarthritis, it’s not necessary to use thearthroplasty of reconstruction of the suspensory ligament.Because of the first carpometacarpal joint osteoarthritis can not be curedin existing condition, transverse carpal ligament reconstruction is a usefulclinical treatment method. |
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