Arthrodesis of the Carpometacarpal Joint of the Thumb by Umeo NISHIKAWA, Tetsuya NISHIKOORI Naotaka SHU and Hayato HIROTANI Department of Orthopaedics

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1 Arthrodesis of the Carpometacarpal Joint of the Thumb by Umeo NISHIKAWA, Tetsuya NISHIKOORI Naotaka SHU and Hayato HIROTANI Department of Orthopaedics Shimane Medical School Shimane Japan We performed 10 fusions of the first carpometacarpal (CM) joints in 10 patients (3 males and 7 females), mean age: 64 years ranging from 29 to 75 years. All patients had clinical and radiological evidences of osteoarthrosis. In the adjacent joints roentgenographic evidence of degenerative arthrosis was present in 7 cases. The mean follow-up period was Z years and 10 months (range: 7 months to 7 years and 3 months). All patients obtained relief of pain and improvement of pinch and grip strengths and ADL. There was no pseudoarthrosis. No one had increased degenerative changes of the other joints of trapezium. We concluded that arthrodesis is a satisfactory procedure for patients who need a stable and painless thumb.

4 180 母指CM関図3-A 節症に対する関節固定術図3-B 術前図3 左母指CM関術直後節症 (29歳, 男性) の単純エックス線像図3-C 術後5年9カとし, 43関節に固定術を行って70%が月無痛, 28 とができ, また握力や pinch 力の低下を防ぐこ %に軽度の疼痛を残すのみという好成績を報告とができる. 術後患側の力を健側に対する百分している. その他にも多少の差はあるが, 率で表すと, Bamberger %以上の著明な除痛効果を得たという多数の報 Kvarnes ら13)は84%の力を, 石田ら11)は91%の告がある1),2),5),12)-14),18),19). われわれの症例もすべての患者で疼痛は軽減し, 安静時痛は100%, 動時痛は70%, 圧痛は90%が運それぞれ消失した. 関節固定術によって, 安定した母指を得るこら2)は98%の握力と93%の握力と81%の握力を, key pinch pinch 力をそれぞれ得ており, その他諸家による報告でも60 90%の握力や pinch 力を獲得している. われわれの症例でも85 95%の力を得ることが

6 1) Alberts, K.A, and Engkvist, O.: Arthrodesis of the first carpometacarpal joint 33 cases of arthrosis. Acta Orthop. Scand., 60: , ) Bamberger, H.B., Stern, P.J., Kiefhaber, T. R. et al.: Trapeziometacarpal joint arthrodesis: A functional evaluation. J. Hand Surg., 17-A: , ) Carrol, R.E, and Hill, N.A.: Arthrodesis of the carpo-metacarpal joint of the thumb. J. Bone Joint Surg., 55-B: , ) Carroll, R.E.: Arthrodesis of the carpometacarpal joint of the thumb: A review of patients with a long postoperative period. Clin. Orthop., 220: , ) Cavallazzi, R.M. and Spreafico, G.: Trapezio-metacarpal arthrodesis today why? J. Hand Surg., 11-B: , ) Clough, D.A., Crouch, C.C. and Bennett, J. B.: Failure of trapeziometacarpal arthrodesis with use of the Herbert screw and limited immobilization. J. Hand Surg., 15- A: , ) Eaton, R.G. and Littler, J.W.: A study of the basal joint of the thumb. J. Bone Joint Surg., 51-A: , ) Eaton, R.G., Lane, L.B., Littler, J.W. et al.: Ligament reconstruction for the painful thumb carpometacarpal joint: A long-term assesment. J. Hand Surg., 9-A: , ) Kvarnes, L. and Reikeras, O.: Osteoarthritis of the carpometacarpal joint of the thumb: An analysis of operative procedures. J. Hand Surg., 10-B: , ) Stark, H.H., Moore, J.F., Ashworth, C.R. et al.: Fusion of the first metacarpotrapezial joint for degenerative arthritis. J. Bone Joint Surg., 59-A: 22-26, 1977.

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