舟大小关节炎病因与临床诊疗研究进展  

Research progress in etiology and clinical diagnosis and treatment of scaphotrapeziotrapezoid osteoarthritis

作　　者：张必欢 蔡兴博 王斌 张悦 徐永清 ZHANG Bihuan;CAI Xingbo;WANG Bin;ZHANG Yuel;XU Yongqing(Graduate School of Kunming Medical University,Kunming Yunnan,650500,P.R.China;Department of Orthopedics,the 920th Hospital of Joint Logistics Support Force of Chinese PLA,Kunming Yunnan,650032,P.R.China)

机构地区：[1]昆明医科大学研究生院,昆明650500 [2]中国人民解放军联勤保障部队第九二〇医院骨科,昆明650032

出　　处：《中国修复重建外科杂志》2023年第1期101-105,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：云南省创伤骨科临床医学中心资助项目(202102AA310068);云南省骨科与运动康复临床医学研究中心资助项目(ZX20191001)。

摘　　要：目的 总结舟大小关节炎(scaphotrapeziotrapezoid osteoarthritis,STT OA)病因及临床诊疗方法研究进展。方法 查阅国内外近年有关STT OA的相关文献,总结研究进展。结果 STT OA是一种常见骨关节炎,绝经后女性是高发人群,通常经腕部X线片检查即可诊断。目前治疗方式包括保守治疗及手术两类。其中,保守治疗能缓解临床症状,但远期疗效不理想。手术治疗中,关节融合术能较好地缓解患者腕部疼痛,但牺牲了腕关节部分活动度和握力,且有融合失败的风险;舟骨远端切除术和大多角骨切除术具有手术时间短、手术操作简便、对关节囊和韧带损伤小、术后固定时间较短等优点,但容易导致腕骨排列改变及腕背侧镶嵌不稳定;关节置换术能在恢复握力与保留腕关节活动度的基础上缓解疼痛,但有假体脱位风险。结论 目前STT OA治疗方式尚无金标准,关节假体置换术和关节镜下舟骨远端切除术早期疗效满意,但是远期疗效还需进一步研究。Objective To summarize the research progress of scaphotrapeziotrapezoid osteoarthritis(STT) OA and its etiology and clinical treatment. Methods The domestic and foreign literature on STT OA in recent years was reviewed and the research progress was summarized. Results STT OA is a common OA, which is highly prevalent in postmenopausal women and diagnosed by wrist X-ray films. The current treatment methods include conservative treatment and surgery. Among them, the conservative treatment can relieve clinical symptoms, but the long-term effectiveness is not ideal. In surgical treatment, scaphoid arthrodesis can effectively relieve wrist pain, but it sacrifices part of the range of motion and grip strength of the wrist, and there is a risk of fusion failure. Distal scaphoid resection and trapezium resection have the advantages of short operation time, simple operation, less damage to the joint capsule and ligament, and shorter postoperative external fixation time, but they lead to changes in carpal bone alignment and dorsal intercalated segmental instability. Arthroplasty can provide pain relief while restoring grip strength and preserving wrist motion, but there is a risk of dislocation of the prosthesis. Conclusion At present, there is no gold standard for the STT OA treatment. The short-term effectiveness of arthroplasty and arthroscopic distal scaphoid resection are satisfactory, but the long-term effectiveness needs further study.

关 键 词：舟大小关节炎 舟骨远端切除术 大多角骨切除术 关节融合术 关节置换术 

分 类 号：R684.3[医药卫生—骨科学]