Die Daumensattelgelenksarthrose – Aspekte zur Indikationsstellung von Resektionsarthroplastik und Daumensattelgelenksprothese

Zusammenfassung

Die Daumensattelgelenksarthrose stellt die häufigste operationsbedürftige Arthrose an der Hand dar, wenngleich vor jeder operativen Therapie immer die konservativen Maßnahmen ausgereizt werden sollen. Wird bei Fortschreiten der Gelenkabnutzung jedoch anhaltend die Funktion des Daumens und somit der gesamten Hand schmerzbedingt eingeschränkt, ist eine chirurgische Behandlung indiziert. Bereits 1947 publizierte Gervis Ergebnisse nach Entfernung des Trapeziums und leitete damit die Entwicklung einer Vielzahl unterschiedlicher Operationsverfahren ein. Das Hauptproblem nach Resektionsarthoplastiken mit oder ohne Sehneninterposition und/oder Suspension stellt nach wie vor die sehr lange Rehabilitationszeit dar. Nach der Einführung der ersten Prothese des Daumensattelgelenkes durch De la Caffiniere vor 50 Jahren kam es zu einer raschen Entwicklung hin zu den aktuellen modularen, bipolaren Implantaten. Vor allem im deutschsprachigen Raum besteht nach wie vor eine gewisse Skepsis bezüglich der Prothesen, weshalb diese Arbeit beide chirurgischen Verfahren mit besonderem Augenmerk auf die Aspekte der Indikationsstellung beleuchten soll.

Abstract

Base-of-thumb osteoarthritis is the most frequent osteoarthritis of the hand requiring surgical treatment, although conservative treatment options should be exhausted before surgery. If the wear process progresses with continuing pain-related loss of thumb function, thus leading to a loss of function of the whole hand, surgical treatment is indicated. In 1947, Gervis published results after trapeziectomy and heralded the development of a multitude of different surgical procedures. The long time needed for rehabilitation is a major problem of trapeziectomy with or without tendon interposition and/or suspension. After the implementation of the first CMC I prosthesis by De la Caffiniere 50 years ago, a rapid development took place, leading to the current modular bipolar implants. Especially in the German-speaking world, there is still some scepticism regarding these prostheses, which is why this review aims to illuminate both surgical procedures with a special focus placed on the aspects of indication.

Schlüsselwörter

Arthroplastik - Endoprothese - Resektions-Arthroplastik - Resektions-Actionspiel-Arthroplastik - Daumensattelgelenksprothese - Indikationsstellung

Keywords

resection arthroplasty - indication - base-of-thumb osteoarthritis - CMC I prosthesis

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