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.
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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
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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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