为了报道一个描述不清的病因,在梯形切除术和软组织基底关节置换术后疼痛,在核成像的帮助下诊断。
5名患者(4名女性和1名男性)平均年龄62岁(范围,59-65岁)平均疼痛7个月(范围,2-11个月)在基底关节置换术后。所有案件都涉及优势手。包括25mCi99mTc亚甲基二膦酸盐骨闪烁显像和单光子发射计算机断层扫描(CT)在内的高级成像显示,拇指掌骨基部和残余梯形之间有强烈的示踪剂摄取。计算机断层扫描证实了这些骨骼之间的邻接。症状归因于这一发现,并进行了翻修手术,包括梯形切除和食指和中指腕掌关节的关节固定术。
平均随访时间为40个月(范围,12-60个月)。握力从平均10.5公斤提高到23公斤,横向箍缩强度从平均3公斤提高到6.75公斤。5例患者中有4例证实了食指掌骨与头状的影像学融合;在一名完全无痛的患者中,这是不确定的。3例患者长指腕掌关节的影像学融合不确定。患者评定的腕关节疼痛评分从35分提高到6分,患者评定的腕关节功能评分从78分提高到14分,并且手臂快速残疾,肩膀,手的得分从37分到18分。
拇指掌骨基部和剩余梯形之间的撞击应被认为是梯形切除术和软组织关节成形术后疼痛的潜在来源。高级成像(骨闪烁显像和单光子发射CT和标准CT)有助于确认诊断。
治疗性V.
To report a poorly described etiology for pain after trapeziectomy and soft tissue basal joint arthroplasty, diagnosed with the aid of nuclear imaging.
Five patients (4 women and 1 man), average age 62 years (range, 59-65 years) presented with pain an average of 7 months (range, 2-11 months) after basal joint arthroplasty. The dominant hand was involved in all cases. Advanced imaging including 25 mCi 99mTc methylene diphosphonate bone scintigraphy and single-photon emission computed tomography (CT) showed intense tracer uptake between the base of the thumb metacarpal and residual trapezoid. Computed tomography scans confirmed abutment between these bones. The symptoms were attributed to this finding, and revision surgery consisting of excision of the trapezoid and arthrodesis of the index and middle finger carpometacarpal joints was performed.
Mean follow-up was 40 months (range, 12-60 months). Grip strength improved from a mean of 10.5 to 23 kg, and lateral pinch strength improved from a mean of 3 to 6.75 kg. Radiographic fusion of the index finger metacarpal to capitate was confirmed in 4 of 5 patients; it was indeterminate in one patient who was completely pain-free. Radiographic fusion of long finger carpometacarpal joints was indeterminate in 3 patients. Patient-Rated Wrist Evaluation pain scores improved from 35 to 6, Patient-Rated Wrist Evaluation function scores from 78 to 14, and Quick-Disabilities of the Arm, Shoulder, and Hand scores from 37 to 18.
Impingement between the base of the thumb metacarpal and remaining trapezoid should be considered a potential source of pain after trapeziectomy and soft tissue arthroplasty. Advanced imaging (bone scintigraphy and single-photon emission CT and standard CT) are helpful to confirm the diagnosis.
Therapeutic V.