Currently, with the advancement of medical technology and medical devices, more and more artificial joints are being used in orthopedic surgery. For patients with hand joint injuries, artificial joint replacement is a relatively good treatment option. First, it is relatively easy to perform, especially when compared to toe joint free grafting; second, the post-operative results are more positive, with most cases having good mobility at the time of surgery and even better results with early training and proper post-operative methods; lastly, unlike toe joint free grafting Finally, unlike free toe grafts, prosthetic replacements do not cause damage to other areas.
Indications.
1, rheumatoid arthritis, osteoarthritis of the metacarpophalangeal joint.
2, traumatic interphalangeal joint deformity or deficiency, traumatic metacarpophalangeal joint deformity or deficiency.
3, congenital deformity of interphalangeal or metacarpophalangeal joints, etc.
Contraindications.
1.extension and flexion tendons with extensive adhesions and weakness of tendon extension and flexion.
2, active rheumatoid arthritis.
3, metacarpophalangeal joint defect is too large artificial joint fixation is not secure.
4, the patient’s physical condition cannot tolerate the surgery.
Surgical methods
1.Dorsal “S”-shaped longitudinal incision of the interphalangeal joint, about 4 cm long.
2, cut the skin and subcutaneous tissue, pay attention to protect the dorsal finger veins, reveal the extensor tendon, start from the stop of the tendon at the base of the middle phalanx, cut it longitudinally along the proximal phalanx, release the lateral collateral ligament, fully correct the soft tissue adhesion contracture, peel off the joint capsule from the distal end of the proximal phalanx, and retain its attachment at the proximal end of the middle phalanx.
3.The distal end of the proximal phalanx was debrided and the medullary cavity was reshaped with a medullary cavity expander to accommodate the square prosthesis stem, while the proximal end of the middle phalanx was not osteotomized and the medullary cavity was prepared in the same way.
4, try to implant the prosthesis, observe its activity, the bone end should be trimmed smooth, the bone end should not collide with the middle of the prosthesis when extending the finger, otherwise the soft tissue should be further loosened or osteotomy, if the prosthesis moves well, repair the finger extension tendon and close the incision.
5, postoperative interphalangeal joint fixed in extension position, metacarpophalangeal joint fixed in flexion position, 3-5 days after removal of external fixation, start functional exercise.
Comparison.
For hand joint injuries, although there are many treatment methods, but all kinds of surgery have their indications, that is, for different parts of the joint injury, for different ages, different types of work, and different economic situation of patients to use different methods of treatment, in order to get satisfactory results.
1.Joint fusion: the operation is easy, and the postoperative follow-up finds that the joint is stable and strong after the operation, and the swelling and pain of the joint disappears. It is especially suitable for those who have serious damage to the soft tissues around the joints and cannot perform joint reconstruction and manual labor. In addition, the low cost of surgery and the short hospital stay are its advantages. Therefore, fusion is an option for those who need strength and for some relatively unimportant joints, such as the distal interphalangeal joint. However, fusion surgery can result in loss of joint motion and have an impact on the function of the hand. Therefore, it is best not to use fusion surgery for important joints such as the carpometacarpal joint of the thumb and the metacarpophalangeal joint of the fingers.
2.Arthroplasty: The surgery is only to make a stiff joint into a pestle-type pseudo-joint. In order to ensure that this pseudo-joint does not fuse again, the two bony ends can be kept at a certain distance with a kerf pin or lined in the middle with a peri-articular palmar plate or rib cartilage membrane, so that the joint has a certain amount of movement. However, due to scar contracture of the soft tissues around the joint and joint adhesions, the postoperative joint will not be very mobile. Also, due to the removal of joint ligaments, the joint is unstable after surgery and weak when pinching objects with force. Joint fusion is in a relatively unimportant joint, and symptoms such as pain and deformity disappear after surgery, and fist clenching and pinching are strong, and the function of the hand is not affected much, so the patient is satisfied. After arthroplasty, some movement was restored from a stiff or minimally mobile joint, thus improving the function of the hand. However, the stability of the joint is poor when pinching objects, and sometimes there is some pain, swelling, etc.
3.Allograft joint replacement: Because the problem of rejection of the joint capsule and articular cartilage has not been solved, late allograft joints may collapse, deformation, dislocation and even loss of joint mobility and other problems that make the operation fail, so it is not suitable at present.
4, toe joint free graft: After the operation, the patient gets a joint with better mobility and the joint is more stable. However, the operation is complicated and requires a certain level of skill; it is risky and expensive; it also causes some damage to the foot. In view of the use of artificial joints, this surgery is rarely used again at present.
5, artificial joint replacement: In the past 20 years, with the continuous improvement of artificial joint design, the integration of anatomical shape design, bone integration, high-tech materials three new concepts, joint aging, loosening, collapse and other problems are gradually being improved, and thus the effect of artificial joint replacement is getting better and better. After surgery not only the swelling, pain and deformity of the original joint disappears, but also the improvement in joint mobility is the greatest among these procedures. However, after artificial joint replacement, the mobility of the joint ends up being less than the original normal joint in the hand because of the scar contracture of the soft tissues around the joint. In some cases, the soft tissues around the joint are severely damaged, the extensor and flexor tendons are defective, or the skin is in poor condition and cannot be repaired. Further observation is needed to determine how long it will take for the new artificial joint to age and whether the joint will loosen. In addition, joints are more expensive. However, artificial joint replacement is a good indication for light workers who need to perform fine movements. With the mature application of biological reconstruction methods and tissue engineering, it will be possible to solve many of the existing problems, and the artificial joint will become more perfect and its use will become more widespread.
Summary.
1, joint replacement surgery is a better treatment method for patients with hand joint injuries. It is a relatively simple operation, and the postoperative results are positive. It can significantly improve the metacarpophalangeal joint extension and flexion function, improve joint flexibility, and improve the patient’s hand work and self-care ability.
2.The joint improvement after joint prosthesis replacement is greater than that of “arthroplasty” or “free joint grafting”.
3.Prosthetic replacement does not require the removal of other parts of the joint to be displaced to the injured joint.
4, joint replacement can also solve the problem of interphalangeal joint hyperextension and deflection deformity.
5, artificial interphalangeal joint is a hinged prosthesis, for patients with joint ligament damage, the prosthesis can be replaced without affecting the stability of the joint.
6, joint replacement surgery has its own indications, that is, those who want to perform joint replacement should be intact flexor and extensor tendons, the surrounding skin tissue conditions should be good.