Analysis Of Operative Treatment Of The First Carpometacarpal Joint Osteoarthritis With Trapezium Resection And Tendon Suspension

Objectives To investigate the treatment outcomes of trapezium resection combined with1/2 flexor carpal radialis(FCR) tendon suspension fixed and 1/2 flexor carpal radialis(FCR) tendon tamponade in patients who have suffered osteoarthritis of the first carpometacarpal joint.Methods From December 2010 to April 2014, 11 patients from the Department of Hand Surgery in the Second Hospital of Tangshan and the department of Orthopaedics in Yanshan Hospital, who have suffered osteoarthritis of the first carpometacarpal joint, were cured by the surgery of trapezium resection combined with 1/2 flexor carpal radialis(FCR)tendon suspension fixed and 1/2 flexor carpal radialis(FCR) tendon tamponade. There were 8 women and 3 male patients, who aged from 47 to 72, with the mean age of 58 years old, in our study. Four cases with left hand and seven with right hand.The disease duration ranged from 1 to 6 years, all the patients were suffered osteoarthritis of the first carp metacarpal joint with single hand. The main clinical features include: the first dorsal carpometacarpal joint swelling, deformity, pain, limited mobility, with a clear sense of the bone scrape when activity, grip and pinch strength decline, can not carry out normal daily work et al. All patients received a minimum of six month of rest and nonsurgical treatment, and had no effect and accept the surgery. X-ray showed the first carpometacarpal joint osteoarthritis, according to Eaton classification: 3 cases of stageⅡ, 6cases of stage Ⅲ, 2 cases of stage Ⅳ. Based on the inclusion criteria and exclusion criteria, 11 patients were collected, were given the treatment of trapezium resection combined with 1/2 flexor carpal radialis(FCR) tendon suspension fixed and 1/2 flexor carpal radialis(FCR)tendon tamponade. Postoperative treatment include: immobilization with forearm plaster, passive interphalangeal join three days later, Kirschner wire and plaster removal and initiative functional exercise six weeks later, normal use of the thumb after 12 weeks. All the patients were followed up for 14 to 36 months, with an average of24 months. Functional assessmen is according to the modified MAYO score, score 90 points or more for the excellent, 81-90 divided into good, 65-80 divided into approve and65 points or less poor.Results After an average of 24 months follow-up, all patients have no pain, functional recovery is good. According to the modified MAYO score, preoperative score is(27.27 ±10.09)points and postoperative score is(87.27 ± 6.84)points. 4 cases wer excellent, 5 cases were good, 2 cases were approve and no case is poor. The rate of excellent and good was81.82%, the difference was statistically significant(P <0.01).Conclusions The treatment that trapezium resection combined with 1/2 flexor carpal radialis(FCR) tendon suspension fixed and 1/2 flexor carpal radialis(FCR) tendon tamponade show both fixed and stable suspension of the first metacarpal, and also fully filling the cavity, fully prevent the metacarpal subsidence. It’s postoperative follow-up showed good effect, can be better improve the function of the first carpometacarpal joint and quality of life in patients with this disease. It is a better way to cure the first carpometacarpal joint osteoarthritis.