掌骨头缺血性坏死一例报告及文献复习  

Avascular necrosis of the metacarpal head:a case report and literature review

作　　者：樊晓磊 汪文涛 王健[2] 廖燚[2] 肖蕊 Fan Xiaolei;Wang Wentao;Wang Jian;Liao Yi;Xiao Rui(Department of Orthopaedic Surgery,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Orthopaedic Surgery Center,Karamay Central Hospital,Karamay 834000,China;Department of Medical Imaging Center,Karamay Central Hospital,Karamay 834000,China)

机构地区：[1]中南大学湘雅医院骨科,长沙410008 [2]新疆克拉玛依市中心医院骨科中心,834000 [3]新疆克拉玛依市中心医院医学影像中心,834000

出　　处：《中华骨科杂志》2021年第7期436-441,共6页Chinese Journal of Orthopaedics

摘　　要：骨缺血性坏死最多见于股骨头和手舟骨,发生在掌骨头的缺血性坏死较为罕见。本文报告1例14岁男性患者,右手疼痛伴活动受限1个月,右手第3、4掌指关节屈伸活动度为70°-30°,右手抓握力约为健侧的60%;X线片示右手第3、4掌骨头关节面变平,局部骨质硬化改变;CT示关节面塌陷、囊性低密度影。经石膏制动、口服非甾体抗炎药、理疗等保守治疗4个月,右手掌指关节疼痛症状逐渐消失。治疗后2年,掌指关节活动度恢复正常,右手抓握力为健侧的105%,MRI示掌骨头局部重塑改变。通过文献回顾分析掌骨头缺血性坏死的临床特点、诊断及治疗方法。掌骨头缺血性坏死的临床表现主要为掌指关节疼痛及活动受限;X线是最常用的检查方法,MRI可以评估早期掌骨头缺血性坏死病变;掌骨头缺血性坏死多见于有创伤病史的青少年患者;由于骨骼有重塑的潜力,青少年掌骨头缺血性坏死可通过保守治疗愈合。Osteonecrosis is the most common disorder in femoral head and scaphoid.However,avascular necrosis(AVN)in metacarpal head is a rare disease.In the present study,a 14-year-old male patient complained of right-hand pain with a limited range of motion for one month.Physical examination showed that the active flexion was 70°and the extension was limited to 30°of the metacarpophalangeal(MCP)joints.The grip strength decreased to 60%of the contralateral hand.X-rays demonstrated flattening and sclerotic changes in the long finger and ring finger of metacarpal head.CT scanning indicated cystic,osteochondral defects and sclerotic changes in metacarpal head.Imaging examination further confirmed the diagnosis of AVN in the long metacarpal finger and ring finger.After conservative treatments including splint immobilization,non-steroidal anti-inflammatory drugs(NSAIDs)and physiotherapy,the local pain symptoms of the MCP joint gradually disappeared.The range of motion of MCP joint returned to normal with the grip strength score as 105%of the contralateral hand.MRI confirmed excellent remodeling and regeneration in the metacarpal head at two years later.The clinical characteristics,diagnosis and treatments of AVN of metacarpal head were reviewed.Although radiograph examination is commonly used,early-stage osteonecrosis of the metacarpal head should be confirmed by MRI.Given the rarity of this disorder,there is no consensus on the treatments.Metacarpal necrosis is the more common disorder in adolescent patients with a history of trauma.Considering the potential of bone remodeling,juveniles with metacarpal head necrosis could recover by conservative treatments.

关 键 词：掌指关节 缺血性坏死 掌骨头 骨质硬化 关节面 低密度影 活动受限 非甾体抗炎药 

分 类 号：R681.7[医药卫生—骨科学]