1.Arthroscopic partial trapeziectomy and suture button suspensionplasty in the treatment of first carpometacarpal joint athrosis
Zhe ZHAO ; Hongli GENG ; Jianquan LIU ; Yongsheng LI ; Jianwen YIN ; Xiaoqiang CHEN ; Guanghui WANG ; Xiangyu CHENG ; Jiabei LI ; Zhiqin DENG ; Aozhengzheng DONG ; Manyi WANG ; Xiaofei ZHENG ; Wencui LI
Chinese Journal of Orthopaedics 2024;44(1):25-32
Objective:To analyze the clinic effects of arthroscopic partial trapeziectomy and suture button suspensionplasty in the treatment of first carpometacarpal joint (CMCJ) Eaton stage II/III arthrosis.Methods:A retrospective study was conducted on a total of 15 cases (16 hands) of patients including 5 males (1 bilateral) and 10 females with CMCJ stage II/III arthrosis who underwent surgical treatment at the first affiliated hospital of Shenzhen university from January 2020 to June 2022, with mean age of 56.7±6.4 years (range, 46-75 years). The duration from pain to treatment was 7.8±3.2 months (range, 4-14 months). X-ray showed narrowing of CMCJ with osteophytes and distal radial subluxation. All the patients were treated with arthroscopic partial trapeziectomy and suture button suspensionplasty. The preoperative and last postoperative follow-up radiographs, visual analogue scale (VAS), thumb's Kapandji scores, disabilies of the arm, shoulder, and hand (DASH) scores, grip and pinch strength and time to return to work were compared.Results:All cases were followed up for 19.6±6.3 months (range, 11-36 months). The postoperative X-ray showed all the CMCJs were reduced with a normal height of first metacarpal. The mean time for patients to return to their daily activities was 18.69±3.70 d and the mean time to return to work was 24.63±4.91 d. The average VAS score decreased from 6.56±1.15 preoperatively to 1.00 (0.75, 1.25). The preoperative Kapandji's score was 8.00±0.82 and the postoperative Kapandji's score was 8.00 (7.25, 9.00). The average DASH values improved from 24.06±3.19 to 4.00 (3.00, 5.00). The were significant differences except for Kapandji score ( Z=-4.905, P<0.001; Z=-0.121, P=0.905; Z=-4.846, P<0.001). The mean grip and pinch strength showed improvement from an average of 16.4 (14.13, 18.68) kg and 1.70±0.35 kg to 26.14±3.27 kg and 3.58±0.91 kg with significant difference ( Z=-4.617, P<0.001; t=-7.669, P<0.001). Conclusion:Arthroscopic partial trapeziectomy and suture button suspensionplasty is a minimally invasive surgery for the treatment of first CMCJ Eaton stage II/III arthrosis. By this technique, the patients' existing instability and pain problems can be solved.
2.Advances in the Treatment of Osteochondral Lesions of the Talus
Yongsheng LI ; Aozhengzheng DONG ; Zeqi HUANG ; Wencui LI ; Zhenhan DENG
Journal of Sichuan University (Medical Sciences) 2024;55(2):273-278
Osteochondral lesion of the talus(OLT)is a localized cartilage and subchondral bone injury of the talus trochlea.OLT is caused by trauma and other reasons,including osteochondritis dissecans of the talus(OCD)and talus osteochondral tangential fracture.OLT can develop from being asymptomatic to subchondral bone cysts accompanied by deep ankle pain.OLT tends to occur on the medial and lateral sides of the talar vault.OLT seriously affects the patients'life and work and may even lead to disability.Herein,we reviewed advances in the treatment of OLT and the strengths and weaknesses of various treatments.Different treatment methods,including conservative treatments and surgical treatments,can be adopted according to the different subtypes or clinical symptoms of OLT.Conservative treatments mostly relieve symptoms in the short term and only slow down the disease.In recent years,it has been discovered that platelet-rich plasma injection,microfracture,periosteal bone grafting,talar cartilage transplantation,allograft bone transplantation,reverse drilling under robotic navigation,and other methods can achieve considerable benefits when each of these treatment methods is applied.Furthermore,microfracture combined with platelet-rich plasma injections,microfracture combined with cartilage transplantation,and various other treatment methods combined with anterior talofibular ligament repair have all led to good treatment outcomes.

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