桡侧腕屈肌腱悬吊结合掌骨间韧带重建治疗第一腕掌关节骨关节炎  

Treaanont of the first trapeziometacarpal osteonrthritis with dynamic suspension sling arfla-oplasty and intennetacarpal ligament reconstruction

作　　者：赵建勇[1] 阚世廉[1] 宿晓雷[2] 张远林[2] 张植生[2] 刘振利[2] 陈广先[2] 

机构地区：[1]天津医科大学天津医院手外科,天津300211 [2]河北医科大学沧州中西医结合临床医学院手外科

出　　处：《中华手外科杂志》2012年第4期193-195,共3页Chinese Journal of Hand Surgery

摘　　要：目的评价大多角骨切除，桡侧腕屈肌腱悬吊结合掌骨基底间韧带重建治疗第一腕掌关节骨关节炎的疗效。方法采用Scheker技术，应用大多角骨切除，桡侧半桡侧腕屈肌腱重建第一、二掌骨基底间韧带，并与剩余肌腱自身悬吊控制掌骨基底背侧半脱位，并形成肌腱填塞物内置大多角骨切除遗留空间控制掌骨下沉等手术步骤，治疗第一腕掌关节骨关节炎6例。术后手部功能评价指标包括握力（glp strength），捏力（key-pinch），第一腕掌关节直观模拟疼痛标尺法（visualanaloguescales，vAS）及第一腕掌关节有效活动度评分（KapandjiScore），术后12个月随访X线前后位片第一掌骨基底．舟骨远关节面间距，评价手术疗效。结果术后随访时间为12—26个月，平均15个月。手术前后疼痛（vAS）平均分值为7．0／1．6；握力平均为11／22kg；捏力平均为1．8／3．4k；Kapandjiscore平均为6．0／8．7；12个月时测量X线前后位片第一掌骨基底．舟骨远关节面间距平均值为8．8mm。结论大多角骨切除，桡侧腕屈肌腱动力性悬吊结合掌骨基底间韧带重建，最大程度地接近了该部位韧带解剖及生物力学方面的结构，可有效治疗第一腕掌关节骨关节炎。Objective To investigate the treaanent outcomes of suspension sling arthroplasty of the first trapeziometacarpal joint with flexor carpal, radialis（FCR） tendon to stabilize the base of the first metacarpal after trapezium removal in patients who have suffered osteoarthritis of the first trapeziometacarpal joint. Methods Six cases of the first trapeziometacarpal joint osteoarthritis were treated using Scheker＇ s techniques. After removing the trapezium the intermetacarpal ligament between the tirst and second metacarpal bases was reconstructed with half of the FCR tendon which was sewed back to its intact half to form a pinecone in order to prevent the dorsal subluxation and proximal migration of the thumb metacarpal. Postoperative evaluations included grip strength, key-pinch strength, visual analogue scales （VAS） and Kapandji Score. X-rays were taken 12 months after the surgery to measure the distance between the first metacarpal base and distal scaphoid articular surface. Results Follow-up was an average of 15 months, ranging from 12 to 26 months. Postoperative VAS of pain decreased from 7.0 to 1.6. Grip strength increased from 11 to 22 kg, while key pinch increased from 1.8 to 3.4 kg. Kapandji Score increased from 6.0 to 8.7. The average space between the first metacarpal base and distal scaphoid articular surface was 8.8 into on A-P view X-ray. Conclusion Dynamic suspension sling arthroplasty of the first trapeziometacarpal joint stabilizes the base of the first metacarpal after trapezium removal. It achieves the greatest degree of being close to the anatomical and biomeehanical structure of the ligament and plays an effective role for treating this kind of disease.

关 键 词：腕掌关节 骨关节炎 关节成形术 

分 类 号：R684.3[医药卫生—骨科学]