Episode Transcript
Dr. Miller: Are there surgical solutions for your painful hand arthritis? We're going to talk about that next on Scope Radio.
Announcer: 向大发娱乐的专家大发娱乐提供有关您今天面临的最大健康问题的深入信息. The Specialists with Dr. Tom Miller is on The Scope.
Dr. Miller: Hi, I'm Dr. Tom Miller and I'm here with Dr. Doug Hutchinson. 他是犹他大学的整形外科教授. 道格，我有很多来找我的病人随着年龄的增长，他们的手上都有关节炎. 他们不时地问我是否有任何手术解决他们的疼痛.
Dr. Hutchinson: 每个人都会在某个时间点患上手部关节炎，只要大发娱乐持续的时间足够长. 大多数手部关节炎是人们生活中的一部分，我认为这是适当的. 手术并不能解决所有的问题, 但毫无疑问，有些人的手指会患上关节炎，每天都会受到伤害，而且在厨房里做某些事情时也会受到影响, doing certain things in the garden, doing certain sports activities, and those we probably in some situations can help a lot.
Dr. Miller: How do we do that?
Dr. Hutchinson: For example, 在手指中，患关节炎最常见的地方是最后一个关节的尖端附近, called the distal interphalangeal joint, right underneath your nail. 有些人长出的囊肿会成为指甲上的问题，而且很疼. 如果大发娱乐能消除一些关节炎，这些问题就能得到解决.
Primarily, 如果手指关节僵硬疼痛，x光片显示有关节炎, which is common, one of the things we'll do the most commonly is fuse that joint. 这就意味着把一颗螺丝钉穿过一块骨头插入另一块骨头，使那个关节有效地消失. 你不能在最后弯曲它，但它会一直保持笔直.
Dr. Miller: And that eliminates the pain?
Dr. Hutchinson: 这完全消除了疼痛，其他关节仍然让你很好地使用你的手. Functionally, you're normal without that last joint working.
Dr. Miller: 手上有什么特别的关节比其他关节更适合手术吗?
Dr. Hutchinson: Yeah, other than the DIP joint of the fingers, which is the last joint near the nail, the base of the thumb, which is all the way back closer to your wrist. 有些人甚至认为他们的手腕疼痛，但实际上是拇指的底部在伤害他们. 通常情况下，病人很难掌握某些握法. They won't want to shake hands as much. They really hate the fact that they can't open a jar at home. 他们必须把它交给他们的妻子或丈夫来弄清楚. It's generally a thumb pain problem that is really, 在人类的世界里，拇指被大发娱乐用手做的事情淹没了, 通过拇指关节施加的力比原先预期的要大.
Dr. Miller: 你会做类似的稳定手术吗在关节上放一个针或螺丝?
Dr. Hutchinson: Yeah. For a thumb arthritis, 最常见的解决方法是移除拇指根部的骨头, 也就是说骨头的两端互相摩擦造成了疼痛, now one of them is gone. There's no longer a bone grinding on a bone. “关节炎”这个词的意思是“关节”，“itis”是炎症. 我告诉我的病人，如果你没有“地球”，你就不会有关节炎. The getting rid of the "arth" is either a fusion, like we do in the distal joint of the finger, 或者切除骨头，这意味着它仍然可以很好地移动，而不是融合. 疼痛消失了，大发娱乐用肌腱来大发娱乐稳定关节.
Dr. Miller: 对于远端指间关节炎或拇指关节炎，您是否建议在手术前进行保守治疗?
Dr. Hutchinson: Yes. We always recommend conservative care first, 大多数情况下，这对很多人来说在一段时间内都是有效的. 对于拇指关节炎，主要的治疗方法是给他们装夹板. 夹板是没有人想戴在手上的东西，也没有人想戴在大拇指上, 但它是在晚上戴的，理论上没有人会在半夜用拇指. It allows the thumb to rest. 这可能会让你在白天把夹板拿下来，用拇指进行正常活动时感觉更好.
We always want them to avoid certain activities. 如果你有拇指关节炎，你不会想用手摇曲柄打开罐头的. You want to go out and buy an automatic can opener. That's something our hand therapists insist on. They think that should be done; at age 20 we should all get automatic can openers.
Dr. Miller: In your opinion, what would be the best conservative therapy? What do you advise patients to take?
Dr. Hutchinson: 大发娱乐通常会让他们在晚上戴一个固定拇指的夹板. 大发娱乐给他们一种绑带式的夹板，白天很容易戴，他们想戴的时候就可以戴. When they don't want to they can not wear it at all. 当他们抓东西时，这有时会有大发娱乐，给他们更多的支持，减少他们的痛苦.
If they get to the point where it's worse, 大发娱乐经常给他们注射，一次可以大发娱乐他们两到三个月，真正让他们的疼痛消失, again, can delay the surgery if they want to have the surgery. 有些人每六个月就来找我说：“再给我打一针吧. I don't want that surgery. I ain't got time for that. Let me just have three, five, six months of peace, please."
Dr. Miller: What is the durability of the surgery? Is it long-lasting?
Dr. Hutchinson: Yes. 拇指关节炎的手术实际上是大发娱乐医院里最好的手术之一. It works well in most any surgeon's hands. There are different procedures that can be done, all of which work about the same or as well as the others. 我会提醒病人，这需要三个月的时间保持良好状态，并戴上夹板, and therefore it's a longer rehabilitation than they would like.
Other than that being a negative, the rest of it is positive. They maintain their motion. They actually increase their grip strength a little bit. Their pain is effectively 100% resolved at that particular joint. Again, 一个手上有很多关节炎的人是不会让其余的关节炎消失的, but that one is usually the one that is causing the most problem.
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updated: May 16, 2019
originally published: January 19, 2016