へバーデン結節に対する人工関節置換術—整容的観点からの評価—

Evaluation of Silicone Implant Arthroplasty for Heberdenʼs Nodes from an Aesthetic Perspective

はじめに

　加齢に伴う変形性関節症による手指の変形は，関節の疼痛や可動域制限に伴う機能損失だけでなく，外観の醜状に伴う心理的負担や社会性の低下にもつながることがある。遠位指節間関節（distal inter phalangeal：以下，DIP関節）の変形性関節症をへバーデン結節と呼ぶが，手指の変形性関節症の中でも罹患割合が圧倒的に高い 1）2）。へバーデン結節の手術治療として関節固定術が一般的である 3）が，DIP関節が動かなくなることが受け入れられない患者には，シリコンインプラントを使用した人工関節置換術を適応している 4）。今回，へバーデン結節に対し人工関節置換術を行った症例の，術前後の成績および患者視点による整容性の変化が術後満足度に与える影響について評価を行ったので，報告する。

　We performed distal interphalangeal (DIP) joint arthroplasty using silicone implants for symptomatic Heberdenʼs nodes in 89 fingers of 42 female patients. We assessed pre- and postoperative range of motion (ROM), grip strength, pain, patient-reported outcomes, and satisfaction. The average postoperative follow-up period was 14.5 months (range: 5–60 months). Although DIP joint flexion angle and ROM significantly decreased, extension lag significantly improved. Pain, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores, Hand 20 scores, and aesthetic satisfaction showed significant improvement. Postoperative satisfaction (very satisfied or satisfied) was 83.1％ of 71 fingers. Factors significantly correlated with overall postoperative satisfaction included implant type, QuickDASH score, aesthetic satisfaction, and postoperative pain. No correlation was found with age, operated finger, postoperative flexion angle, extension lag, ROM, or grip strength. These findings suggest that aesthetic outcome influences postoperative satisfaction in DIP joint arthroplasty.