单根肌腱多韧带重建治疗急性第一腕掌关节脱位  

Multi ligaments reconstruction with single tendon with for the treatment of acute joint dislocation of the first car-pometacarpal

作　　者：张煜[1] 范卫民[1] 徐南伟[2] 顾卫东[2] 

机构地区：[1]南京医科大学第一附属医院骨科,江苏南京210029 [2]南京医科大学附属常州市第二人民医院骨科,江苏常州213003

出　　处：《中国骨伤》2013年第12期1037-1040,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的：探讨桡侧腕长伸肌腱重建第一腕掌关节周围4束韧带治疗急性第一腕掌关节脱位的临床疗效。方法：自2008年12月至2012年10月，对4例急性第一腕掌关节脱位的患者切开复位后采用单根桡侧腕长伸肌重建关节周围4组韧带，即背侧韧带，掌侧韧带，桡背侧韧带，第一、二掌骨间韧带；其中男3例，女1例；平均年龄38．7岁（22~63岁）。术后根据X线片、JAMAR握力测试、拇指关节活动范围（rangeofmotion，ROM）、活动时疼痛视觉模拟评分（visualanaloguescale，VAS）等指标评价手术效果。结果：所有患者获随访，时间6~40个月，平均19个月。术后伤口均I级愈合。术后1、3、6个月x线片未见第一腕掌关节脱位复发，关节间隙无明显狭窄退变。JAMAR握力测试患侧恢复至健侧的60％N90％。ROM测定3例屈伸、收展活动恢复正常，1例内收受限。拇指活动时疼痛VAS评分0-1分。结论：对于急性第一腕掌关节脱位，桡侧腕长伸肌腱重建关节周围韧带可恢复关节稳定性，改善功能。To explore the clinical outcomes of multi-ligaments reconstruction with single tendon in treating a cute joint dislocation of the first carpometacarpal. Methods： From December 2008 to October 2012,4 patients with acute dis- location of the first carpometacarpal were treated with single carpi radialis longus tendon to reconstruct periarticular four liga ments, which included dorsal ligament, palmar ligament, dorsal radiocarpal ligament, and intermetacarpal ligament between the first and second. There were 3 males and 1 female aged from 22 to 63 years old with an average of 38.7. X-ray,JAMAR grid strength testing,range of motion of carpometacarpal joint and VAS score were used to evaluate clinical outcomes. Results：All patients were followed up from 6 to 40 months with an average of 19 months. The wound were healed well at stage I No dislo cation of the first carpometacarpal joint and signs of joints degeneration occurred on X-ray at 1,3 and 6 months after operation. JAMAR grip strength recovered from 60 percent to 90 percent of health wide. The results of ROM showed 3 cases recovered flexion and extension of joints and 1 case limited adduction. VAS score was 0 to 1. Conclusion： For acute dislocation of the first carpometacarpal joint, reconstruction four ligaments with single carpi radialis longus tendon can be considered the selected treatment, which can restores joint stability and improve joint function.

关 键 词：修复外科手术 韧带 腕关节 脱位 

分 类 号：R684.7[医药卫生—骨科学]