大多角骨切除联合袢钢板悬吊治疗第一腕掌骨关节炎的疗效评价  

Trapeziectomy combined with suture-button suspension plasty for the treatment of the first carpometacarpal osteoarthritis

作　　者：徐佳俊 顾晓坤 金如珏 朱伟钢 邓爱东 Xu Jiajun;Gu Xiaokun;Jin Rujue;Zhu Weigang;Deng Aidong(Department of Hand Surgery,Affiliated Hospital of Nantong University,Nantong 226000,China)

机构地区：[1]南通大学附属医院手外科,南通226000

出　　处：《中华手外科杂志》2021年第5期353-357,共5页Chinese Journal of Hand Surgery

基　　金：南通市民生科技项目关键技术应用研究(MS12019022)。

摘　　要：目的通过对大多角骨切除联合袢钢板悬吊治疗第一腕掌骨关节炎的随访研究,评价该术式的治疗效果。方法自2018年1月至2020年1月,共纳人第一腕掌骨关节炎患者(Eaton IE期及以上)13例。所有患者均接受大多角骨切除联合袢钢板悬吊术。术后评价治疗效果,客观评价包括捏力、握力、拇指外展角度(掌侧、桡侧)、拇指对掌功能评分(Kapandji评分)和第一掌骨沉降率,主观评价包括视觉模拟疼痛评分(visual analogue scale,VAS)及上肢功能障碍评分(disabilities of the arm,shoulder,and hand questionnaire,DASH)。结果术后13例患者均获得随访,时间为6〜30个月,平均19个月。末次随访时,患者术后疼痛明显缓解,力量明显提高,关节的活动范围及功能明显改善,且结果差异均有统计学意义(P<0.05)。患者术后第一掌骨的高度得到了很好的维持,第一腕掌关节的功能恢复良好,并能返回以前的工作岗位。按照Robbins腕关节评分标准综合评定手术优良率达84.6%。结论大多角骨切除联合袢钢板悬吊术可明显缓解疼痛,改善第一腕掌关节功能,并能在术后维持第一掌骨的高度,疗效确切,值得推广运用。Objective To investigate the clinical efficacy of trapeziectomy combined with suture-button suspension plasty for the treatment of the first carpometacarpal osteoarthritis.Methods From January 2018 to January 2020,13 patients with the first carpometacarpal osteoarthritis(Eaton stage ID and above)were included.All the patients underwent trapeziectomy combined with suture-button suspension plasty.The clinical efficacy was evaluated after operation.The objective evaluation included pinch strength,grip strength,thumb abduction angle(volar and radial),thumb opposition function score(Kapandji score)and the first metacarpal subsidence rate.The subjective evaluation included visual analogue scale(VAS)and upper limb disabilities of the arm,shoulder,and hand questionnaire(DASH).Results All the 13 patients were follow-up for 6 to 30 months,with an average of 19 months.At the last follow-up,the postoperative pain was significantly relieved,the strength was significantly improved,and the range of motion and function of the joint were significantly improved.The differences were statistically significant(P<0.05).The height of the first metacarpal bone was well maintained,the function of the first carpometacarpal joint recovered well,and the patients could return to their previous job.According to Robbins wrist scoring standard,the excellent and good rate of operation was 84.6%.Conclusion The trapeziectomy combined with suture-button suspension plasty can significantly relieve pain,improve the function of the first carpometacarpal joint,and maintain the height of the first metacarpal bone after operation.It has definite clinical efficacy and is worthy of popularization and application.

关 键 词：腕掌关节 治疗结果 大多角骨切除 袢钢板 悬吊 

分 类 号：R687.3[医药卫生—骨科学]