掌指关节缺损部分关节移植与关节成形的比较△（开放获取）

Comparison of partial articular transplantation versus arthroplasty for metacarpophalangeal defect

摘要:

[目的] 比较第 5 腕掌关节部分移植与关节成形治疗掌指关节缺损的临床疗效。[方法] 回顾性分析 2016 年 3 月— 2022 年 12 月本院收治的 32 例外伤导致掌指关节缺损患者的临床资料，根据术前沟通结果，16 例采用第 5 腕掌关节部分移植治疗，16 例采用关节成形治疗，比较两组围手术期、随访和影像结果。[结果]所有患者均顺利完成手术，术中均无神经血管等严重并发症。移植组的手术时间 [(137.0±16.4) min vs (102.5±12.5) min, P＜0.005] 和术中透视次数 [(28.1±1.4) 次 vs (23.1±0.8) 次, P=0.006] 显著大于成形组，但两组间术中出血量、切口总长度、平均住院时间、住院费用、石膏外固定时间的差异均无统计学意义 （P＞0.05）。32 例患者随访时间平均 （17.7±4.0） 个月，随时间推移，两组术后 VAS 评分和 DASH 评分均显著减少 （P＜ 0.05），而握力、掌指关节 ROM、Carroll 手功能试验评分显著增加 （P＜0.05）。术后 1、3 个月 DASH 评分 [(83.2±3.9) vs (89.9± 5.4), P=0.003; (55.3±6.2) vs (61.4±6.9), P=0.022]、术后 3 个月和末次随访时掌指关节 ROM [(62.5±5.4)° vs (56.6±7.3)°, P=0.033; (82.2±4.3)° vs (76.9±5.2)°, P=0.004]、Carroll 手功能试验评分 [(77.8±4.0) vs (74.9±3.2), P=0.022; (92.6±3.6) vs (88.5±3.2), P=0.004]、 术后 1 个月和末次随访握力 [(26.8±3.7) kg vs (22.9±3.5) kg, P=0.009; (48.9±5.8) kg vs (44.1±5.0) kg, P=0.009] 移植组均明显优于成形组。术后影像方面，两组骨折愈合时间的差异无统计学意义 （P＞0.05），末次随访时移植组的相对关节间隙显著大于成形组 [(1.03±0.68)% vs (0.86±0.11)%, P=0.002]。[结论]第 5 腕掌关节部分移植治疗掌指关节部分缺损，尤其是伴有肌腱、韧带止点缺损的患者，可更好重建关节完整性和稳定性，更利于掌指关节功能恢复。

Abstract:

[Objective] To compare the clinical consequence of partial transplantation of the fifth carpometacarpal joint versus arthroplasty in the treatment of metacarpophalangeal defects. [Methods] A retrospective study was conducted on 32 patients who underwent surgical treatment for metacarpophalangeal defect due to trauma in our hospital from March 2016 to December 2022. According to preoperative surgeon-patients discussion, 16 patients were treated with partial transplantation of the fifth carpometacarpal joint, while other 16 patients were with then conventional arthroplasty. The documents regarding perioperative period, followup and imaging were compared between the two groups. [Results] All patients in both groups had corresponding surgical procedures performed successfully without serious complications such as neurovascular injuries. The transplantation group consumed significantly longer operative time [(137.0±16.4) min vs (102.5± 12.5) min, P＜0.005] and more intraoperative fluoroscopy times [(28.1±1.4) vs (23.1±0.8), P=0.006] than the arthroplasty group. However, there were no significant differences in intraoperative blood loss, total incision length, hospital stay, hospitalization cost and postoperative plaster fixation time between the two groups (P＞0.05). With time elapsed during the followup period lasted for (17.7±4.0) months in a mean, the VAS and DASH scores in both groups were significantly decreased (P＜0.05), while grip strength, metacarpophalangeal ROM and Carroll hand function test scores were significantly increased (P＜0.05). The transplantation group proved significantly superior to the arthroplasty group in terms DASH score [(83.2±3.9) vs (89.9±5.4), P=0.003; (55.3±6.2) vs (61.4±6.9), P=0.022] 1 and 3 months postoperatively, metacarpophalangeal ROM [(62.5±5.4)° vs (56.6±7.3)°, P=0.033; (82.2±4.3)° vs (76.9±5.2)°, P=0.004] and Carroll score [(77.8±4.0) vs (74.9±3.2), P=0.022; (92.6±3.6) vs (88.5±3.2), P=0.004] 3 months after operation and at the latest follow-up, as well as grip strength [(26.8±3.7) kg vs (22.9±3.5) kg, P=0.009; (48.9±5.8) kg vs (44.1±5.0) kg, P=0.009] 1 month after surgery and at the last follow-up. As for postoperative imaging, there was no significant difference in fracture healing time between the two groups (P＞0.05), whereas the transplantation group had significantly greater relative joint space than the arthroplasty group at the last follow-up [(1.03±0.68)% vs (0.86±0.11)%, P= 0.002]. [Conclusion] Partial transplantation of the fifth carpometacarpal joint for metacarpophalangeal partial defect, especially with tendon and ligament insertion defect, does better rebuild the integrity and stability of the joint, and is more conducive to the functional recovery of the metacarpophalangeal joint.