Follow-up Observation Of Trapeziectomy With Modified Abductor Pollicis Longus Suspension Arthroplasty For The Treatment Of First Carpometacarpal Joint Osteoarthritis

Purpose:To evaluate the efficacy of trapeziectomy with modified abductor pollicis longus suspension arthroplasty for the treatment of first carpometacarpal joint osteoarthritis.Methods:From 2017 to 2020,7 patients with first carpometacarpal arthritis are treated with trapeziectomy and modified abductor pollicis longus suspension arthroplasty.Surgical treatment is given after definite diagnosis on the basis of medical history,symptoms,physical examination and imaging examination.The operative method is trapeziectomy with modified abductor pollicis longus suspension arthroplasty.After operation,the thumb is fixed in a slightly abduction position with plaster.After 2 weeks,the plaster is replaced by thermoplastic brace.Four weeks after operation,the gradual functional training begin after removing brace.Partial weight-bearing training is initiated after 8 weeks and complete weight-bearing training after 12 weeks.The patients are followed up 1,3 and 6 months after operation,and evaluated according to the range of motion of thumb,pain score,upper limb dysfunction score and first metacarpal proximal displacement.Results:All the 7 patients are female,age from 40 to 61 years old,with an average age of 52 years old.The course of the disease ranges from 1 month to 60 months,with an average of 21.7 months.There are 1 case on the left side,4 cases on the right side and 2 cases on both sides.Among them,6 cases are diagnosed as osteoarthritis and 1 case is diagnosed as rheumatoid arthritis.Postoperative follow-up ranges from 8 to 47 months(mean 28.6 months).The Kapandji score is 4.67±2.40 preoperatively and 8.56 ± 1.13 three months postoperatively.The VAS score is 7.11±2.42 preoperatively and 1.44±0.88 at last follow-up.The Quick-DASH score is 61.88±16.87 preoperatively and 24.49±14.08 at last follow-up.first carpometacarpal joint space is 8.66 ± 0.70mm preoperatively and 6.36±1.74mm three month postoperatively.The first metacarpal proximal displacement is 27.19%±17.40%three months postoperatively.Conclusion:The trapeziectomy with modified abductor pollicis longus suspension arthroplasty for the treatment of the first carpometacarpal osteoarthritis can relieve the pain of the thumb,improve the range of motion of the thumb and significantly improve the function of the upper limb.it is an effective and recommended method for the treatment of the first carpometacarpal joint osteoarthritis.