8/9/2019 Rhizarthrose QATAR 2014
1/45
AE^WZ GFG LCE@Z B^ZD^EZEW
GD^EWZEB@ J[FC@ZEK^, FJ, XDJ
8/9/2019 Rhizarthrose QATAR 2014
2/45
NBWEGW< CWZKC-B^ZD^EZEW
• Arkquk`t, jesbnie`m, gcstiy jeskbsk
• Xrk
vbik`gk 2;% (2558) ! 24% (>8>8)
• >,4% ca jesbneiety (2558) ! 7,1% (>8>8)
• 2% ca EX ([WB)
8/9/2019 Rhizarthrose QATAR 2014
3/45
NBWEGW - CWZKCB^ZD^EZEW CAZDK DB@J B@J AE@MK^W
• Db`j brtdretes es arkquk`t
• 1=%♈ ;;% ♎ batkr ;; ykbrs ca bmk jc dbvk b
rbjecicmegbi CB
• Wyfptcfbteg e` >8% ca gbsks
• ]etdcut rbjec-gie`egbi gcrrkibtec` `ketdkr bt c`k jby, cr
jure`m kvciutec`
• Efpcrtb`t au`gtec`bi jkflget, sbfk bs ^B (Wpbgko >88:)
8/9/2019 Rhizarthrose QATAR 2014
4/45
« ^DE\B^ZD^CWEW ¿- 2WZ GFG LCE@Z CB
• Acrkstekr (257=)
• >`j CB e` arkquk`gy (9 EXJ)
• Bmk-bjlustkj prkvbik`gk< 2;%♈?
=% ♎ - rbrk nkacrk ;8 yrs (4% ca
wcfk`)
• ;=% ca GFG-2 CB batkr 18
• =2-288 yrs < syfptcfbteg >1%
akfbiks, 2:% fbiks (\db`m >88>)V
♈ :4 b`s
Bmk-spkgeflg prkvbik`gk rbtks (Dbbrb >88:)
Okiimrk` mrbjk >, 7, :
Okiimrk` mrbjk 7, :
8/9/2019 Rhizarthrose QATAR 2014
5/45
• Iembfk`tcus ibxety• Dcrfc`bi
• Brteguibr dypkrfcneiety (Lñ`ssc` 255;, >884)
• Ejecpbtdeg
• Fbrab`, Kdikr ‗Jb`ics
• Au`gtec`bi cvkricbj (fbiks, TQEtd gk`tury)
• Zrbufb < Brteguibr arbgturk, iuxbtec`
• Dypcpibseb ca trbpkzeuf
KZECICMU
Xrkvk`tevk trkbtfk`t 3
8/9/2019 Rhizarthrose QATAR 2014
6/45
EZ EW WCA^KR[K@Z, EW
ZDK^KWCFKZDE@M EWDC[IJ O@C]ZDBZ E BF @CZ
B]B^K CA 3
8/9/2019 Rhizarthrose QATAR 2014
7/45
NECFKGDB@EGW
• Zdk 2st GFG lce`t es b gcfpikx c`k
• Gcfpbrkj tc b sbjjik c` b sgciecteg dcrsk
8/9/2019 Rhizarthrose QATAR 2014
8/45
NECFKGDB@EGW
• Zdk lce`t es e`dkrk`tiy u`stbnik ^cik ca iembfk`ts
8/9/2019 Rhizarthrose QATAR 2014
9/45
ZF LCE@Z E@WZBNEIEZU
• Abvcrkj ny jyspibseb ca tdk trbpkzk b`j tdk puii ca
tk`jc`s (BXI +++)
8/9/2019 Rhizarthrose QATAR 2014
10/45
8/9/2019 Rhizarthrose QATAR 2014
11/45
NECFKGDB@EGW
• Demdiy gc`strbe`kj lce`t< b 2om puip
pe`gd sdkbre`m icbjs ca 27 om
• " gdc`jrbi gc`strbe`ts, jcrsc-
rbjebi suniuxbtec`, 2st wkn
sdcrtk`e`m,
FX lce`t fkgdb`egbigc`skquk`gks
8/9/2019 Rhizarthrose QATAR 2014
12/45
EZ EW B ^KMEC@BI JEWKBWK
• Escibtkj ZF lce`t e`vcivkfk`t
es rbrk
• ZF + WZZ(78-18%), Zz-
Zzcãjk (7;%), Zz->`j
fktbgbrpbi (41%)
• Ea WZZ es e`vcivkj ZF (58%)
8/9/2019 Rhizarthrose QATAR 2014
13/45
EZ EW B ^KMEC@BI JEWKBWK
• ^kmec`bi lce`t e`stbneiety<
• FX +++< Arc`tbi cr sbmettbi e`stbneiety -gbusk ca abeiurk ca surmegbi trkbtfk`t _Jk Wfkt, >881V -
Wtbneiesbtec` ea FX kxtk`sec` 0 78¸
• 2st wkn spbgk < Gicsurk - gbusk ca abeiurk casurmegbi trkbtfk`t _Fegdc`, 254;. Jk Wfkt, >881V
8/9/2019 Rhizarthrose QATAR 2014
14/45
EZ EW B ^KMEC@BI JEWKBWK
• Wcat-tessuk rkmec`bi jeskbsk< Gbrpbi tu``ki< :-:1%
ca gbsks? Zk`je`etes< AG^, Jk Rukrvbe`―s, tremmkr
fl`mkr
8/9/2019 Rhizarthrose QATAR 2014
15/45
GIE@EGBIKTBFE@BZEC@
• Wem`s ca CB<
• Fkgdb`egbi pbe` (jure`m pe`gd -
wkbre`m temdts, tur`e`m b oky)
• Xbe` bt pbipbtec`, mreje`m tkst +,
• Wy`cvetes, jkacrfety,...
• Icss ca strk`mtd
• Zdk`br btrcpdy
• Jc `ct acrmkt tc kxbfe`k tdk FX lce`t
8/9/2019 Rhizarthrose QATAR 2014
16/45
^BJECICMU
• Wpkgebi T-rbys
e`gejk`gks (Obpb`jle)
• Wem`s ca CB<
gc`jk`sbtec`,
sgikrcses, lce`t
`brrcwe`m,cstkcpdytks (2st
wkn), suniuxbtec`,…
8/9/2019 Rhizarthrose QATAR 2014
17/45
Wpkgebi efbme`m tkgd`equks brk uskikss
8/9/2019 Rhizarthrose QATAR 2014
18/45
Kbtc` (25=7, 254:) Jkii (25=4, 2558) Gcftkt (>882)
Wtbjk 8E`stbneietå. E`tkriem`k `crfbi
cu åibrme. Wuniuxbtec`
råjugtenik
Wtbjk 2Gc`tcurs brteguiberks
`crfbux
E`tkriem`k `crfbi cu fe`efk
pe`gkfk`t cu iåmärk
cståcgc`jk`sbtec` scus-
gdc`jrbik. Xbs jk suniuxbtec`,
cu j―cståcpdytk
Fe`efk pe`gkfk`t.
Cstkcpdytks. Wuniuxbtec` `c`
råjugtenik
Wtbjk >
Fe`efk pe`gkfk`t cu iåmärk
cståcgc`jk`sbtec` scus-
gdc`jrbik. Cståcpdytks cu
gcrps åtrb`mkrs 9 >ff
Xe`gkfk`t, cståcgc`jk`sbtec`
scus-gdc`jrbik. Cståcpdytks.
Wuniuxbtec` 9 2/7 surabgk
brteguiberk fåtbgbrpek``k
Jåtårecrbtec` ZF,
dypkrkxtk`sec` FX råjugtenik
Wtbjk 7
Xe`gkfk`t fbrquå, måcjks kt
cståcgc`jk`sbtec` scus-
gdc`jrbiks. Wuniuxbtec`
vbrebnik. Arbmfk`ts
brteguiberks 0 >ff
Xe`gkfk`t fbrquå, måcjks kt
cståcgc`jk`sbtec` scus-
gdc`jrbiks. Cstkcpdytks.
Wuniuxbtec` 0 2/7 surabgk
brteguiberk fåtbgbrpek``k.
Jåtårecrbtec` ZF kt FX,
dypkrkxtk`sec` FX `c`
råjugtenik
Wtbjk : Brtdrcsk ZF + WZZ Brtdrcsk ZF kt WZZ. Brtdrcsk ZF kt WZZ
8/9/2019 Rhizarthrose QATAR 2014
19/45
Z^KB ZFK@Z
• Fkjegbi
• Xdbrfbgcicmegbi ZZZ (Xbe`-oeiikrs, @WBEJ, sicw-bgtec`
b`te-brtdretes fkjegbtec` ieok scjeuf gdc`jrcekte`suiabtk), crtdcses +++, Xdysegbi ZZZ (pbrbafl`, dkbt,…)
• Wtkrcej e`lkgtec`s, Dybiurc`eg bgej e`lkgtec`s
• Es sbej tc nk kaflgek`t e` 58% ca gbsks - pbe` rkieka e`
4-22 ykbrs (Bfcr)
8/9/2019 Rhizarthrose QATAR 2014
20/45
C^ZDCWKW
• =1% ca pbtek`ts wetd fcjkrbtk e`vcivkfk`t b`j ;:% wetd
skvkrk jeskbsk dbvk b 18% efprcvkfk`t wetd b` crtdcses(Wwembrt, 2555)
# Nk`kflgk es effkjebtk (cr `kvkr)
• Zdk typk ca crtdkses +/- pdysectdkrbpy dbs `c e`uk`gk c`tdk kvciutec` bt 1 wkkos (]blc`, Bust L Xdysectdkr >88;) - Xbtek`ts prkakr
tc effcneiezk FX & ZF lce`t cvkr c`iy tdk ZF (]kess, L Db`j Zdkr >88:) • @c jeaakrk`gk nktwkk` sdcrt (wrest es arkk) cr ic`m crtdcsks, nut
pbtek`ts prkakrrkj sdcrt crtdcsks (]kess, L Db`j Zdkr >888)
• @c jeaakrk`gk nktwkk` remej cr suppik crtdcses, nut pbtek`tsprkakrrkj tdk fcrk suppik c`k (Nuurok, Gie` ^kdbn 2555)
8/9/2019 Rhizarthrose QATAR 2014
21/45
Z^KBZFK@Z
• K[IB^ ^kgcffb`jbtec`s (\db`m B^J >88=)<
Wurmkry es b` kaflgek`t trkbtfk`t acr GFG lce`t
brtdrcsks b`j gb` nk jc`k e` pbtek`ts wdc brkpbe`aui cr wetd b efpcrtb`t au`gtec`bi jkflget batkr
abeiurk ca fcrk gc`skrvbtevk trkbtfk`ts (AJ^ 6
14).
8/9/2019 Rhizarthrose QATAR 2014
22/45
W[^MK^U
• Fb`y tkgd`equks
• Wyfptcfbteg trkbtfk`t
• Brtdrcjkses (Fuiikr, 25:5)
• Cstkctcfy (]eisc`, 25=7)
• Brteguibr rkskgtec` (e.k. trbpkzkgtcfy w/wc stbneiesbtec`,
e`tkrpcsetec`,…) _Mkrves, 25:5? Arcefsc`, 25=8? Kbtc` 25=7V
• Xrcstdksks - efpib`ts _Wwb`sc`, 25=>V cr prcstdkses _Jk ib Gbafl`eärk,25=:V
• Xrkvk`tevk Zrkbtfk`t 3
B td j e 27 A[
8/9/2019 Rhizarthrose QATAR 2014
23/45
ZF B^ZD^CJKWEW
• [subiiy prcpcskj e` ycu`m pkcpik (tc fbe`tbe`
tdker strk`mtd) wetd scfk icss ca fcneiety
• @c jeaakrk`gk e` rksuits e` tdk (rbrk, rktrcspkgtevk)
gcfpbrbtevk stujeks
• 4:% sbtesabgtcry rksuits (>; ykbrs A[)
• :8% rk-e`tkrvk`tec` _GdbfbyV (Dbrjwbrk rkfcvbi,@c`u`ec` :%, Jk-brtdrcjkses 1%)
• « Guiturbi ¿ e`jegbtec`s tdbt jefe`esd
Brtdrcjkses ‗27 yrs A[
8/9/2019 Rhizarthrose QATAR 2014
24/45
Z^BXK\EKGZCFU
• Xbrtebi cr gcfpiktk
• ]etd / wc e`tkrpcsetec`
• ]/wc stbneiesbtec`
www.fbetresk-crtdcp.gcf
• Zrbpkzekgtcfy biwbys ikbj tc b
jefe`utec` ca oky-pe`gd strk`mtd_Qb`jk`nrcugok, 255=V.
# Bii pbtek`ts weii gcfpibe` ca b icss ca
strk`mtd batkr trbpkzekgtcfy +++
http://www.maitrise-orthop.com/
8/9/2019 Rhizarthrose QATAR 2014
25/45
XCZK@ZEBI X^CNIKFW
• Zdufn gciuf` weii
gciibpsk e`tc tdk
jkbj spbgk wetd tefk(8,; ff / ykbr)
• Bnutfk`t wetd
trbpkzcej b`j/crsgbpdcej
B
N
Zrbpåzebi Wpbgk ^btec 6 B/N
Objeybib & Jcw`e`m, LDW, 2551.
8/9/2019 Rhizarthrose QATAR 2014
26/45
KNF< Z^BXK\EKGZCFU +/- E@ZK^XCWEZEC@+/- WZBNEIEWBZEC@ (JBQEW - X^CWXKGZEQKWZ[JEKW)
• 247 pbtek`ts, wetd 7 & 2> fc`tds A[
• 4>% mccj rksuits, 14% suaflgek`t strk`mtd
• Ic`m rkgcvkry (1 fc`tds). « @crfbi ¿
Fcneiety
• @c jeaakrk`gk nktwkk` mrcups# @c gcrrkibtec` nktwkk` tdk fktbgbrpbi
sdcrtk`e`m b`j oky-pe`gd strk`mtd
8/9/2019 Rhizarthrose QATAR 2014
27/45
GCGD^B@K JBZBNBWKWUWZ ^KQ >88;
• = stujeks (; tkgd`equks) wetd 74: pbtek`ts wkrkkiemeniks
• Mbe` ca pbe` ca >=-;=/288, ca au`gtec`bi jkflget24->:/288
• @c jeaakrk`gk nktwkk` tkgd`equks
• Ikss gcfpiegbtec`s e` tdk sefpik trbpkzekgtcfymrcup (p98.882)
• 22% fcrk gcfpiegbtec`s e` tdk I^ZE mrcup(p68.87)
8/9/2019 Rhizarthrose QATAR 2014
28/45
ZF X^CWZDKWKW
• Fb`y jksem`s
• Fcstiy Ark`gd
• 2st gbsk, Jk Ib Gbafl`eärk,
25=:
8/9/2019 Rhizarthrose QATAR 2014
29/45
BJQB@ZBMKW CA ZFX^CWZDKWKW
• Kbriy rkgcvkry (>-7 fc`tds) - @c rkdbneietbtec`
• @c tdufn sdcrtk`e`m (Gb` nk uskj kvk` ea FX
dypkrkxtk`sec`) - kstdkteg
• 288 pts, 47% mccj rksuits (: ykbrs A[ _^km`brj >881V)
= b`s
8/9/2019 Rhizarthrose QATAR 2014
30/45
GCFXIEGBZEC@W
• Bncut 2;%, tdbt e`grkbsk wetd tefk
• Iccsk`e`m (+/- 2;%), jesicgbtec` (+/- =%), trbpkzebi
arbgturk,…
• G/E< Zrbpkzebi jyspibseb, sdcrt cr tde` trbpkzeuf,
FX brtdrcjkses, FGI e`suaflsek`gy (FX), WZZ
brtdrcsks (ycu`m pbtek`t)
8/9/2019 Rhizarthrose QATAR 2014
31/45
W[^QEQBI CA ZF X^CWZDKWKW
• Wurvevbi rbtk nktwkk` < 14 tc 45% (jkib Gbafl`eärk, >882? @egdcibs kt Gbijkrwcj, 255>? Qb`
Gbpkiik kt bi., 2555? Gdborbnbte kt bi., 255=? Bpbrj kt
Wbe`t-Gbst, >88=? Woytb kt bi., >88;? ]bgdti kt bi., 255=?
Gcftkt, >888? Nrutus kt Oe``k`, >88:? Lbgcuikt, >88;?
Wgdudi, >882? Ikjcux, 255=? Nbjeb kt Wbfnb`jbf,>881)
• 21% rk-cpkrbtec` bt :2 fc`tds A[ (Bpbrj kt Wbe`t-Gbst, >88=)
• Fcst rk-cpkrbtec` brk jc`k wetde`
tdk flrst ykbr (Bpbrj kt Wbe`t gbst, >88=, Gcftkt,>888)
8/9/2019 Rhizarthrose QATAR 2014
32/45
CZDK^ ZKGD@ER[KW
• Zc fbe`tbe` tdk tdufn ik`mtd< pbrtebitrbpkzekgtcfy wetd e`tkrpcsetec` (pyrcgbrnc`,
Brtkic`,…) - @c skreks puniesdkj
• ZF lce`t jk`krvbtec`
8/9/2019 Rhizarthrose QATAR 2014
33/45
^KFKFNK^
• Weiegc`k efpib`t dbvk nkk` bnb`jc`kj
juk tc tdk demd `ufnkr ca
gcfpiegbtec`s e`giuje`m seiegc`etes
8/9/2019 Rhizarthrose QATAR 2014
34/45
^DE\B^ZD^CWK
• Ik trbetkfk`t jk råaårk`gk rkstk ib trbpåzkgtcfek (kt sks
vbreb`tks)
• ^åsuitbts sbtesabesb`ts (4;%), fb`quk jk acrgk,
rågupårbtec` ic`muk
• Ib prctdäsk kst e`jequåk gdkz iks sulkts pius îmås (k`
i―bnsk`gk jk g/e) - nc`s råsuitbts que sk fbe`tek``k`t.
28-2;% jk gcfpiegbtec`s è ic`m tkrfk.
• Iks butrks tkgd`equks sc`t k` åvbiubtec` (mbrjkr ib
ic`mukur ju pcugk 6 kstdåtequk kt ac`gtec`)
8/9/2019 Rhizarthrose QATAR 2014
35/45
@CZ ZC AC^MKZ<]EIWC@
CWZKCZCFU
• Wteaa b`j pbe`ikss tdufn wetd skvkrk jkacrfety -
Jc b rk-crek`tbtec` ca tdk tdufn
8/9/2019 Rhizarthrose QATAR 2014
36/45
X^KQK@ZEQKZ^KBZFK@Z 3
EW EZ ]C^ZD JCE@M EZ 3
8/9/2019 Rhizarthrose QATAR 2014
37/45
AC^ ]DEGD XBZEK@ZW 3
• Ucu`m
• ]etdcut (cr iefetkj)
gbrteibmk bitkrbtec`
• ZF e`stbneiety +/-
trbpkzebi jyspibseb
8/9/2019 Rhizarthrose QATAR 2014
38/45
X^KQK@ZEQK Z^KBZFK@Z
• Wkgtec` ca b`tkrecr
bnkrrb`t flnkrs ca tdkBXI (\b`gciie)
• @c skreks puniesdkj
• Xrcnbniy uskikss
8/9/2019 Rhizarthrose QATAR 2014
39/45
X^KQK@ZEQK Z^KBZFK@Z
• Iembfk`tcpibsty e` pbtek`ts wetd
e`stbneiety
• Ik Qekt rkpcrtkj 25 pbtek`tsefprcvkj cut ca b skreks ca >; nut
gc`sejkrkj rksuits bs u`-prkjegtbnik
8/9/2019 Rhizarthrose QATAR 2014
40/45
Kbtc`-Iettikr typk
8/9/2019 Rhizarthrose QATAR 2014
41/45
N^[@KIIE IEMBFK@ZCXIBWZU(25=:)
Zdk BXI es pbrbiiki tc tdk pib`k ca tdk `bei pibtk
8/9/2019 Rhizarthrose QATAR 2014
42/45
^KW[IZW CA N^[@KIIE―WIEMBFK@ZCXIBWZU BZ254 FC@ZDW
J. Ik Qekt
8/9/2019 Rhizarthrose QATAR 2014
43/45
ZF LCE@Z B^ZD^CWGCXU
• Jknrejkfk`t ca sy`cvetes
•
Wdre`obmk ca ZF iembfk`ts
8/9/2019 Rhizarthrose QATAR 2014
44/45
CWZKCZCFEKW
• Qbsguibrezkj Lce`t trb`sakr (^cux >88:)
• @c`-vbsguibrezkj cstkctcfy (Mcunkbu >88;)
8/9/2019 Rhizarthrose QATAR 2014
45/45
ZDB@O UC[ AC^ UC[^ E@QEZBZEC@