微型带线锚钉加关节囊紧缩术对类风湿性关节炎患者第一掌指关节脱位的疗效研究  

Curative effect of micro-strip line anchors combined with posterior capsulorrhaphy in the treatment of first metacarpophalangeal joint dislocation in rheumatoid arthritis

作　　者：聂智兴 高晨鑫 韩大鹏 丁盛 王凌椿 张建坡 欧阳桂林 Nie Zhixing;Gao Chenxin;Han Dapeng;Ding Sheng;Wang Lingchun;Zhang Jianpo;Ouyang Guilin(Joint Surgery Department,Guanghua Hospital Affiliated to Shanghai University of Tradittonal Chinese Medicine,Shanghai 200052,China;Joint Surgery Department,Guanghua Hospital Integrated Traditional Chinese and Western Medicine,Shanghai 200052,China)

机构地区：[1]上海中医药大学附属光华医院关节外科,200052 [2]上海市光华中西医结合医院关节外科,200052

出　　处：《中国综合临床》2019年第1期49-53,共5页Clinical Medicine of China

基　　金：上海市卫生和计划生育委员会科研项目(20144Y0160).

摘　　要：目的研究微型带线锚钉加关节囊紧缩术对类风湿性关节炎(rheumatoid arthritis,RA)第一掌指关节脱位的短中期疗效。方法选择2015年1月至2016年12月上海市光华中西医结合医院收治的58例RA第一掌指关节脱位患者,根据随机数字表法分为研究组(n=20)、关节置换组(n=19)、非手术组(n=19)。术后评定指标:按照《中华医学会手外科学会上肢部分功能评定试用标准》观察伤口愈合情况。比较3组手术疗效,采用Michiga手功能评价量表(michigan hand outcomes questionnaire,MHQ)、关节炎影响测量量表2(arhritis impact measurement scale 2,AIMS2)分别于治疗前及治疗后6、12个月进行手功能和生活质量评估。结果研究组、关节置换组患者术后切口均获得Ⅰ期愈合,无任何早期并发症。按照《中华医学会手外科学会上肢部分功能评定试用标准》评定手术疗效,其中研究组患者优15例,良3例,差2例,优良率90.0%,关节置换组优15例,良3例,差1例,优良率为94.7%。治疗后6个月,研究组、关节置换组和非手术组MHQ评分均有明显提高[(48.36±8.24)分与(73.06±10.55)分,(47.56±7.75)分与(81.42±8.54)分,(48.75±8.85)分与(65.91±8.26)分](F值分别为33.19、35.12、28.42,P均<0.05),但研究组(73.06±10.55)分、关节置换组(81.42±8.54)分的MHQ评分显著高于非手术组(65.91±8.26)分(P<0.05),关节置换组显著高于研究组(P均<0.05)。治疗后12个月,MHQ评分在研究组(82.45±7.18)分和关节置换组(84.36±6.33)分之间比较,差异均无统计学意义(P>0.05)。治疗后6、12个月研究组[(216.51±35.28)分与(230.28±23.51)分]、关节置换组[(221.45±31.63)分与(234.15±21.42)分]的AIMS2评分显著高于非手术组[(192.69±41.31)分与(200.43±28.42)分](P均<0.05)。治疗后6、12个月,AIMS2评分在研究组和关节置换组之间比较,差异均无统计学意义(P均>0.05)。结论微型带线锚钉加关节囊紧缩术治疗RA第一掌指关节关节脱位,关节复位Objective To study the short-term and medium-term effects of mini- strip anchor and capsulotomy in the treatment of first metacarpophalangeal joint dislocation in rheumatoid arthritis(RA).Methods From January 2015 to December 2016, fifty-eight RA patients with first metacarpophalangeal joint dislocation were randomly divided into study group (20 cases), joint replacement group (19 cases) and non-operation group (19 cases). Postoperative evaluation indexes: the wound healing was observed in accordance with " trial standard of functional evaluation of upper limbs of Chinese Medical Association Hand Surgery Society" . The surgical outcomes of the three groups were compared.The hand function and quality of life were assessed by Michiga Hand Outcomes Questionnaire (MHQ) and arthritis impact measurement scale 2 (AIMS2) before treatment, 6 months after treatment and 12 months after treatment.Results All the patients in the study group and the joint replacement group healed by first intention without any early complications.According to the criteria of upper extremity functional evaluation of Chinese Medical Association, the curative effect of the operation was evaluated.In the study group, 15 cases were excellent, 3 cases were good, 2 cases were poor, the excellent and good rate was 90.0%.In the joint replacement group, 15 cases were excellent, 3 cases were good, 1 case was poor, and the excellent and good rate was 94.7%.After treatment for 6months, the MHQ scores were improved significantly in the three groups ((48.36±8.24) vs.(73.06±10.55);(47.56±7.75) vs.(81.42±8.54);(48.75±8.85) vs.(65.91±8.26)) (F=33.19, 35.12, 28.42, P<0.05). The MHQ scores of study group ( (73.06±10.55)points) and joint replacement group( (81.42±8.54)points) were significantly higher than those of non-operation group ((65.91±8.26)points) (P<0.05), and the MHQ scores of joint replacement group were significantly higher than those of study group (P<0.05). At 12 months after treatment, there was no significant difference in MHQ score betwee

关 键 词：微型带线锚钉 关节囊紧缩术 类风湿性关节炎 掌指关节脱位 短中期疗效 

分 类 号：R687.4[医药卫生—骨科学]