Skafoid distal pol rezeksiyonu ile skafotrapezial trapezoidal artroz tedavisi

Year 2014, , 431 - 436, 03.09.2014

Augusto Marcuzzi Hakan Ozben Antonio Russomando

https://doi.org/10.3944/AOTT.2014.14.0156

Abstract

Amaç: Bu çalışmanın amacı skafoidin distal çeyreğinin rezeksiyonunda kullanılan cerrahi tekniği tanımlamak ve rezeksiyon sonrası pirokarbon implant ile tedavi edilen hastalarla sadece rezeksiyon ile tedavi edilen hastaların sonuçlarını karşılaştırmaktı.

Çalışma planı: Çalışmada sadece rezeksiyon ile tedavi edilen 9 ve rezeksiyon sonrası implant uygulaması gerçekleştirilen 8 bilek yer aldı. Ortalama takip süresi 77 (dağılım: 24-130) ay idi. Hastaların bilek hareketleri ve kavrama güçleri ölçüldü; ağrıları görsel analog skala (GAS) ile değerlendirildi. Radyografik sınıflandırma Crosby sınıflandırma sistemine göre gerçekleştirilirken, hastaların ameliyat öncesi ve sonrası radyolunat (RL) açıları kaydedildi.

Bulgular: Ameliyat sonrası GAS ağrı skorları sadece rezeksiyon ve implant gruplarında, sırasıyla, 2.1 ve 2.6 olarak bulundu. Ağrı skorlarının her iki grupta anlamlı şekilde azaldığı saptandı (sırasıyla, p=0.007 ve p=0.01). Ortalama RL açısı sadece rezeksiyon uygulanan grupta 14°’den 30°’ye yükseldi (p=0.008. İmplant grubundaki ortalama RL açısı 21°’den 23°’ye yükselmiş bulunsa da, bu farkın anlamlı olmadığı görüldü (p=0.75).

Çıkarımlar: Pirokarbon implant uygulaması ağrı tedavisi için yararlı bir teknik olarak gözükmektedir. Uygulama, skafotrapezial trapezoidal artrit tedavisinde sekonder deformitelerin önlenmesine katkı sağlayabilir.

Keywords

DISI; skafotrapezial trapezoidal artroz; STPI protezi; skafoid distal pol rezeksiyonu.

Treatment of scaphotrapezial trapezoidal osteoarthritis with resection of the distal pole of the scaphoid

Abstract

Objective: The aim of this study was to describe the surgical technique for resection of the distal quarter of the scaphoid and compare the results of patients treated by resection with patients treated by resection with insertion of a pyrocarbon implant.

Methods: The study included 9 wrists treated by resection-only and 8 wrists treated by resection with implant. Average follow-up period was 77 (range: 24 to 130) months. Wrist motion and pinch strength were measured and pain was evaluated using the visual analog scale (VAS). Radiographic classification was performed according to Crosby’s classification system and the radiolunate (RL) angle was measured pre- and postoperatively.

Results: Postoperative VAS pain scores were 2.1 and 2.6 in the in the resection-only and implant group, respectively. Pain scores decreased significantly in both groups (p=0.007 and p=0.01, respectively). The mean RL angle increased from 14º to 30º in the resection-only group (p=0.008). In the STPI implant group, there was an increase in the mean RL angle from 21º to 23º; however, this difference was not significant (p=0.75).

Conclusion: Application of a pyrocarbon implant appears to be useful for pain relief and may help prevent secondary deformities in the treatment of scaphotrapezial trapezoidal arthritis.

Keywords

DISI, resection of the distal pole of the scaphoid, scaphotrapezial trapezoidal arthrosis, STPI prosthesis

References

• Crosby EB, Linscheid RL, Dobyns JH. Scaphotrapezial trapezoidal arthrosis. J Hand Surg Am 1978;3:223-34.
• Wolf JM. Treatment of scaphotrapezio-trapezoid arthritis. Hand Clin 2008;24:301-6.
• Tay SC, Moran SL, Shin AY, Linscheid RL. The clinical implications of scaphotrapezium-trapezoidal arthritis with associated carpal instability. J Hand Surg Am 2007;32:47-54.
• Ashwood N, Bain GI, Fogg Q. Results of arthroscopic debridement for isolated scaphotrapeziotrapezoid arthritis. J Hand Surg Am 2003;28:729-32.
• Garcia-Elias M, Lluch AL, Farreres A, Castillo F, Saffar P. Resection of the distal scaphoid for scaphotrapeziotrapezoid osteoarthritis. J Hand Surg Br 1999;24:448-52.
• Kessler I, Baruch A, Hecht O, Amit S. Osteoarthritis at the base of the thumb. The concept of monoarticular reconstruction. Acta Orthop Scand 1976;47:361-9.
• Srinivasan VB, Matthews JP. Results of scaphotrapeziotrapezoid fusion for isolated idiopathic arthritis. J Hand Surg Br 1996;21:378-80.
• Eiken O. Implant arthroplasty of the scapho-trapezial joint. Scand J Plast Reconstr Surg 1979;13:461-68.
• Haussman P. Long-term results after silicone prosthesis replacement of the proximal pole of the scaphoid bone in advanced scaphoid nonunion. J Hand Surg Br 2002;27:417-23.
• Khoo CT. Silicone synovitis. The current role of silicone elastomer implants in joint reconstruction. J Hand Surg Br 1993;18:679-86.
• Watson HK, Wollstein R, Joseph E, Manzo R, Weinzweig J, Ashmead D 4th. Scaphotrapeziotrapezoid arthrodesis: a follow-up study. J Hand Surg Am 2003;28:397-404.
• Fortin PT, Louis DS. Long-term follow-up of scaphoid-trapezium-trapezoid arthrodesis. J Hand Surg Am 1993;18:675-81.
• Frykman EB, Af Ekenstam F, Wadin K. Triscaphoid arthrodesis and its complications. J Hand Surg Am 1988;13:844-9.
• McAuliffe JA, Dell PC, Jaffe R. Complications of intercarpal arthrodesis. J Hand Surg Am 1993;18:1121-8.
• Garcia-Elias M. Excisional arthroplasty for scaphotrapeziotrapezoidal osteoarthritis. J Hand Surg Am 2011;36:516-20.
• Low AK, Edmunds IA. Isolated scaphotrapeziotrapezoid osteoarthritis: preliminary results of treatment using a pyrocarbon implant. Hand Surg 2007;12:73-7.
• Pegoli L, Zorli IP, Pivato G, Berto G, Pajardi G. Scaphotrapeziotrapezoid joint arthritis: a pilot study of treatment with the scaphoid trapezium pyrocarbon implant. J Hand Surg Br 2006;31:569-73.
• Pequignot JP, D’asnieres de Veigy L, Allieu Y. Arthroplasty for scaphotrapeziotrapezoidal arthrosis using a pyrolytic carbon implant. Preliminary results. [Article in French] Chir Main 2005;24:148-52. [Abstract]
• Ferris BD, Dunnett W, Lavelle JR. An association between scapho-trapezio-trapezoid osteoarthritis and static dorsal intercalated segment instability. J Hand Surg Br 1994;19:338-9.