Cihangir TETİK, Bülent EROL, M. Bekir ÜNAL, Cengiz ÇABUKOĞLU, Yakup YILDIRIM

Trapeziometakarpal eklemin ligament rekonstrüksiyonu ve tendon interpozisyonu artroplastisinde fleksör karpi radyalis tendonunun tamamının kullanılması

Amaç: Başparmak karpometakarpal eklem osteoartritinde fleksör karpi radyalis (FKR) tendonunun tamamının kullanılmasıyla uygulanan ligament rekonstrüksiyonu tendon interpozisyonu artroplastisinin kısa dönem klinik sonuçlarını prospektif olarak değerlendirdik. Çalışma planı: Yedi hastanın ameliyat edilen sekiz başparmağı ortalama 12 ay süreyle izlendi. Altısı kadın, biri erkek olan hastaların yaş ortalaması 57 (dağılım 51-71) idi. Hastaların tümünde ağrı ve günlük aktivitelerde yetersizlik vardı ve konservatif tedavi yöntemleriyle tatminkar sonuç alınamamıştı. Ameliyat sonrası üçüncü ve 12. aylarda klinik, fizik muayene ve radyolojik bulguları değerlendirildi. Sonuçlar: Tüm hastalarda ağrı şikayeti tamamen kayboldu; hepsi günlük aktivitelerini yapabilir hale geldi. On ikinci ayda, kavrama, uç yakalama ve anahtar yakalama güçlerinde sırasıyla %46, %54 ve %30 oranında artış saptandı. Tüm başparmakların mobilitesinde gelişme sağlandı; altı tanesi küçük parmağın tabanına ulaşabilirken, ikisi proksimal interfalangeal eklem çizgisine değebiliyordu. Başparmak ağ açısı 25 dereceden 39 dereceye yükseltildi ve bu şekilde korundu. Radyolojik olarak tüm eklemler ameliyat sonrasında stabilitesini korudu; metakarp tabanında subluksasyon görülmedi, artroplasti mesafesinin yüksekliğinde anlamlı azalma saptanmadı. Hastaların el bilek fleksiyon gücünde azalma olmadı. Çıkarımlar: Uyguladığımız ligament rekonstrüksiyonu tendon interpozisyonu artroplastisiyle başparmağın stabil ve fonksiyonel restorasyonunun sağlandığı sonucuna varıldı.

Anahtar Kelimeler:

Artroplasti, Osteoartrit, Tendon transferi, Tendonlar, para-artiküler, El baş parmağı, Ligamentler, eklem, Karpal kemikler

Ligament reconstruction and tendon interposition arthroplasty of the trapeziometacarpal joint with the use of the entire flexor carpi radialis tendon

Objectives: We prospectively analyzed the short-term clinical outcomes of ligament reconstruction tendon interposition arthroplasty with the use of the entire flexor carpi radialis (FCR) tendon in osteoarthritis of the carpometacarpal joint of the thumb. Methods: The study included eight thumbs of seven patients (6 women, 1 men; mean age 57 years; range 51-71 years) who underwent arthroplasty for osteoarthritis at the base of the thumb. All the patients had pain and disability in daily activities, which did not respond satisfactorily to conservative treatment modalities. Clinical and radiologic evaluations were made at three and twelve months postoperatively. Results: All patients had complete relief of pain and returned to normal daily activities. At the end of 12 months, improvements achieved in grip, tip pinch and key pinch strengths were 46%, 54%, 30%, respectively. Mobility of the thumbs improved; six thumbs could reach the base of the little finger, and two thumbs the crease of the proximal interphalangeal joint. The mean web angle of the thumb which had been increased from 25$\circ$ to 39$\circ$ was well preserved postoperatively. Radiographically, all of the thumbs remained stable; no subluxation of the metacarpal base or definite loss of height of the arthroplasty space were observed. The strength of the wrist flexion was preserved postoperatively. Conclusion: Ligament reconstruction tendon interposition arthroplasty with the use of entire FCR tendon provides stable and functional restoration of the thumb.

Keywords:

Arthroplasty, Osteoarthritis, Tendon Transfer, Tendons, Para-Articular, Thumb, Ligaments, Articular, Carpal Bones,

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1.Murray PM. Current status of metacarpophalangeal arthroplasty and basilar joint arthroplasty of the thumb. Clin Plast Surg 1996;23:395-406.
2. Pellegrini VD Jr. Osteoarthritis at the base of the thumb. Orthop Clin North Am 1992;23:83-102.
3. Amadio PC, Millender LH, Smith RJ. Silicone spacer or tendon spacer for trapezium resection arthroplasty-comparison of results. J Hand Surg [Am] 1982;7:237-44.
4. Ashworth CR, Blatt G, Chuinard RG, Stark HH. Siliconerubber interposition arthroplasty of the carpometacarpal joint of the thumb. J Hand Surg [Am] 1977;2:345-57.
5. Burton RI, Pellegrini VD Jr. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg [Am] 1986;11:324-32.
6. Tomaino MM, Pellegrini VD Jr, Burton RI. Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition. J Bone Joint Surg [Am] 1995;77:346-55.
7. Varitimidis SE, Fox RJ, King JA, Taras J, Sotereanos DG. Trapeziometacarpal arthroplasty using the entire flexor carpi radialis tendon. Clin Orthop 2000;(370):164-70.
8. Froimson AI. Tendon arthroplasty of the trapeziometacarpal joint. Clin Orthop 1970;(70):191-9.
9. Eaton RG, Glickel SZ, Littler JW. Tendon interposition arthroplasty for degenerative arthritis of the trapeziometacarpal joint of the thumb. J Hand Surg [Am] 1985;10:645-54.
10. Kleven T, Russwurm H, Finsen V. Tendon interposition arthroplasty for basal joint arthrosis. 38 thumbs followed for 4 years. Acta Orthop Scand 1996;67:575-7.
11. Braun RM. Total joint arthroplasty at the carpometacarpal joint of the thumb. Clin Orthop 1985;(195):161-7.
12. Burton RI. Basal joint implant arthroplasty in osteoarthritis. Indications, techniques, pitfalls, and problems. Hand Clin 1987;3:473-87.
13.Carroll RE, Hill NA. Arthrodesis of the carpo-metacarpal joint of the thumb. J Bone Joint Surg [Br] 1973;55:292-4.
14. Eaton RG. Replacement of the trapezium for arthritis of the basal articulations: a new technique with stabilization by tenodesis. J Bone Joint Surg [Am] 1979;61:76-82.
15. Gervis WH, Wells T. A review of excision of the trapezium for osteoarthritis of the trapezio-metacarpal joint after twenty- five years. J Bone Joint Surg [Br] 1973;55:56-7.
16. Kleinman WB, Eckenrode JF. Tendon suspension sling arthroplasty for thumb trapeziometacarpal arthritis. J Hand Surg [Am] 1991;16:983-91.
17. Peimer CA, Medige J, Eckert BS, Wright JR, Howard CS. Reactive synovitis after silicone arthroplasty. J Hand Surg [Am] 1986;11:624-38.
18. Swanson AB. Disabling arthritis at the base of the thumb: treatment by resection of the trapezium and flexible (silicone) implant arthroplasty. J Bone Joint Surg [Am] 1972;54:456-71.
19. Swanson AB, Swanson GG, Maupin BK, Hynes DE, Jindal P. Failed carpal bone arthroplasty: causes and treatment. J Hand Surg [Am] 1989;14(2 Pt 2):417-24.
20. Cooney WP, Linscheid RL, Askew LJ. Total arthroplasty of the thumb trapeziometacarpal joint. Clin Orthop 1987;(220):35-45.
21. Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg [Am] 1984;9:692-99.