拇指掌指关节置换+指间关节融合术对类风湿关节炎拇指纽扣畸形的矫形效果观察  

Orthopaedic effect of metacarpophalangeal replacement combined with interphalangeal joint fusion on thumb button deformity in rheumatoid arthritis patients

作　　者：沈中鸣 潘培军 戴号 王凌椿 SHEN Zhongming;PAN Peijun;DAI Hao(Operating Room, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052, China)

机构地区：[1]上海市光华中西医结合医院手术室,上海200052

出　　处：《实用手外科杂志》2019年第1期3-5,共3页Journal of Practical Hand Surgery

基　　金：上海市长宁区卫生和计划生育委员会项目(项目编号:20154Y008)

摘　　要：目的探讨拇指掌指关节置换+指间关节融合术对类风湿关节炎拇指纽扣畸形的治疗效果。方法2016年1月-2017年6月,对5例类风湿关节炎(Rheumatoid Arthritis,RA)导致的纽扣畸形拇指的掌指关节行Swanson假体置换术、指间关节融合术,术后1个月通过Carroll手功能试验评分法评定患者的手部功能,并观察患指的对掌功能和患者对患指外观的满意度。结果术后5例伤口均获得Ⅰ期愈合,随访6～12个月未发生假体移位、假体断裂、假体周围骨折等并发症。术后1个月,患者的Carroll评分明显升高,对掌功能损害值明显下降,且患者对拇指外观的满意度评分明显升高。结论拇指掌指关节置换+指间关节融合术可改善RA拇指纽扣畸形患者的拇指对掌功能,从而提高手部整体功能,且患者对畸形矫正效果满意。Objective To investigate the therapeutic effect of metacarpophalangeal replacement combined with interphalangeal joint fusion on thumb button deformity in rheumatoid arthritis patients. Methods Five patients with rheumatoid arthritis-induced thumb boutonniere deformity were treated by metacarpophalangeal replacement using swanson prosthesis combined with interphalangeal joint fusion.The patient’s hand function was assessed by Carro II test score 1 month after operation, and the opposition function of the affected finger and the patient’s satisfaction with the appearance of the finger were investigated as well. Results All the patients underwent first-stage healing in the operative wounds.No complications such as prosthesis displacement, prosthesis rupture, and periprosthetic fracture occurred during the following-up of 6-12 months. One month after surgery, the patient’s Carro II score was significantly increased, the opposition function impairment value decreased significantly, and the patient’s satisfaction score on the appearance of the thumb was significantly increased. Conclusion Metacarpophalangeal joint replacement combined with interphalangeal joint fusion can improve the thumb opposition function of RA patients with thumb button deformity, thus improve the overall function of the hand, and the patients are satisfactory with the orthopaedic effect.

关 键 词：类风湿关节炎 拇指 纽扣畸形 掌指关节置换 指间关节融合术 

分 类 号：R687.4[医药卫生—骨科学]