Handchir Mikrochir Plast Chir 2019; 51(03): 185-192
DOI: 10.1055/a-0900-4130
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Stellenwert der ST-Arthroplastik in der Therapie der STT-Arthrose bei gleichzeitiger Rhizarthrose

Importance of ST arthroplasty in the treatment of STT osteoarthritis and concomitant basal thumb osteoarthritis
Maximilian Hermann Lorenz Halim
1   Friedrich-Alexander-Universität Erlangen-Nürnberg, Plastisch- und Handchirurgische Klinik
,
Raymund E. Horch
1   Friedrich-Alexander-Universität Erlangen-Nürnberg, Plastisch- und Handchirurgische Klinik
,
Alexander D. Bach
1   Friedrich-Alexander-Universität Erlangen-Nürnberg, Plastisch- und Handchirurgische Klinik
2   St.-Antonius-Hospital gGmbH Eschweiler, Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie – Wiederherstellungschirurgie
› Author Affiliations
Further Information

Publication History

14 January 2019

20 April 2019

Publication Date:
05 June 2019 (online)

Zusammenfassung

Hintergrund Die Rhizarthrose gehört zu den häufigsten Arthroseformen. Nicht selten besteht gleichzeitig auch eine STT-Arthrose. Als operativer Goldstandard gelten die verschiedenen Modifikationen der Resektionsarthroplastik. In einer retrospektiven Studie wurden die postoperativen Ergebnisse der Resektions-Suspensions-Arthroplastik (RSA) nach Lundborg, modifiziert nach Wulle mit und ohne zusätzliche ST-Arthroplastik miteinander verglichen.

Patienten und Methoden Im Rahmen der Studie wurden 50 Patienten mit symptomatischer Daumensattelgelenksarthrose (Stadium III und IV) nachuntersucht. Davon sind 21 Patienten mittels konventioneller modifizierter Resektions-Suspensions-Arthroplastik nach Lundborg (RSA) und 29 Patienten mit derselben Technik und zusätzlicher ST-Arthroplastik (RSA-plus) operiert worden. Es wurden der TDX-Score (Thumb Disability Examination-Score), der Kapandji-Score, das Schmerzniveau und die Kraft im Grobgriff, im Schlüsselgriff, im palmaren Spitzgriff und im Dreifingerspitzgriff erhoben.

Ergebnisse In beiden Gruppen war die Schnitt-Naht-Zeit vergleichbar. Der Gesamt-TDX-Score betrug für die RSA-plus-Gruppe 15,9 ± 19,5 und für die RSA-Gruppe 20,8 ± 24,3 (p > 0,05). Einen marginal signifikanten Unterschied zeigte der Kapandji-Score in der RSA-plus-Gruppe mit 9,5 ± 1,1 und in der RSA-Gruppe mit 8,9 ± 1,6 (p = 0,08). Die Kraft im Grobgriff (RSA-plus: 48,3 ± 21 kPa, RSA: 55,2 ± 24,9 kPa (p > 0,05)), im Schlüsselgriff (RSA-plus: 32,6 ± 15 kPa, RSA: 37,3 ± 15,4 kPa (p > 0,05)), im palmaren Spitzgriff (RSA-plus: 30,6 ± 12,9 kPa, RSA: 34,8 ± 12,4 kPa (p > 0,05)) sowie im Dreifingerspitzgriff (RSA-plus: 36,2 ± 14,2 kPa, RSA: 42 ± 13,6 kPa (p > 0,05)) wiesen in beiden Gruppen keine signifikanten Unterschiede auf. Die Schmerzintensität in Ruhe (RSA-plus: 0,4 ± 1,3, RSA: 1 ± 2,1 (p > 0,05)), bei Bewegung (RSA-plus: 0,7 ± 1,8, RSA: 1,6 ± 2,7 (p > 0,05)) und bei Belastung (RSA-plus: 1,6 ± 2,5, RSA: 2,9 ± 3,4 (p > 0,05)) zeigten sich in beiden Gruppen insignifikant unterschiedlich.

Zusammenfassung In den nachuntersuchten Patientengruppen zeigten sich keine signifikanten Unterschiede in den untersuchten Variablen. Wir stellen somit fest, dass keine Nachteile bestehen eine zusätzliche ST-Arthroplastik zur konventionellen Resektions-Suspensions-Arthroplastik durchzuführen. Wir sind aufgrund der erhobenen Daten der Ansicht, dass die Indikation zur ST-Arthroplastik im Rahmen der RSA großzügig gestellt werden sollte.

Abstract

Background Basal thumb osteoarthritis is one of the most prevalent forms of osteoarthritis worldwide and is frequently associated with osteoarthritis of the STT joint. The surgical gold standard comprises various modifications of arthroplasty resection. A retrospective study compared the postoperative results of Lundborg’s resection-suspension-arthroplasty, modified by Wulle, with and without additional ST arthroplasty.

Patients and Methods In this study, 50 patients with symptomatic basal thumb osteoarthritis (stages III and IV) were examined. Twenty-one of them were treated with conventional resection-suspension-arthroplasty (RSA) and 29 patients were treated with the same technique and additional ST arthroplasty (RSA-plus). The analysis included an assessment of the Thumb Disability Examination (TDX) score, the Kapandji Thumb Opposition score, the Visual Analogue Scale (VAS) pain score as well as grip force, key pinch force, two-point and three-point pinch force.

Results In both groups, the duration of the operation was comparable. The overall TDX score was 15.9 ± 19.5 in the RSA-plus group and 20.8 ± 24.3 in the RSA group (p > 0.05). A marginally significant difference was noted for the Kapandji score, which was 9.5 ± 1.1 in the RSA-plus group and 8.9 ± 1.6 in the RSA group (p = 0.08). There was no significant difference between both groups for grip strength (RSA-plus: 48.3 ± 21 kPa, RSA: 55.2 ± 24.9 kPa (p > 0.05)), key pinch force (RSA-plus: 32.6 ± 15 kPa, RSA: 37.3 ± 15.4 kPa (p > 0.05)), two-point pinch force (RSA-plus: 30.6 ± 12.9 kPa, RSA: 34.8 ± 12.4 kPa (p > 0.05)) and three-point pinch force (RSA-plus: 36.2 ± 14.2 kPa, RSA: 42 ± 13.6 kPa (p > 0.05)). Both groups demonstrated insignificant differences in pain intensity at rest (RSA-plus: 0.4 ± 1.3, RSA: 1 ± 2.1 (p > 0.05)), during movement (RSA-plus: 0.7 ± 1.8, RSA: 1.6 ± 2.7 (p > 0.05)) and under stress (RSA-plus: 1.6 ± 2.5, RSA: 2.9 ± 3.4 (p > 0.05)).

Conclusion The followed-up patient groups demonstrated no significant differences in the examined variables. This leads us to the conclusion that there are no disadvantages associated with performing ST arthroplasty in addition to conventional RSA. In fact, based on the collected data, we suggest that ST arthroplasty should be more widely indicated in the context of RSA.

 
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