桡侧腕屈肌腱部分转位行多韧带重建治疗第一腕掌关节脱位  

Partial transposition of flexor carpi radialis tendon for multiple ligament reconstruction in the treatment of first carpometacarpal joint dislocation

作　　者：赵文隆 林平 李焘 赵驰 徐伟华 叶招明[2] Zhao Wenlong;Lin Ping;Li Tao;Zhao Chi;Xu Weihua;Ye Zhaoming(Department of Orthopedics,Jinhua Hospital Afiliated to Zhejiang University School of Medicine,Jinhua 321000,China;Department of Orthopedics,the Second Affliated Hospital of Zhejiang University School of Medicine,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属金华医院骨科,金华321000 [2]浙江大学医学院附属第二医院骨科,杭州310003

出　　处：《中华手外科杂志》2023年第5期403-406,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨小切口下采用桡侧腕屈肌腱部分转位、多韧带重建治疗第一腕掌关节脱位的临床疗效。方法自2019年11月至2022年8月, 我们收治第一腕掌关节脱位的患者7例, 均采用切取1/2桡侧腕屈肌腱转位重建第一腕掌关节背侧韧带复合体及前斜韧带进行治疗, 术后指导功能锻炼, 定期随访, 比较治疗前后疼痛、日常生活评价及关节功能情况。结果本组患者均获得随访, 时间为3~36个月, 平均(14.7±12.0)个月。疼痛采用视觉模拟评分(visual analogue scale, VAS)评价, 术前为6.9±0.7, 末次随访1.0±1.3;日常生活情况采用Quick DASH评分评价, 术前为49.7±12.0, 末次随访11.4±7.2;关节功能情况采用Krimmer评分评价, 术前为45.7±13.7, 末次随访84.3±6.7。术前及末次随访结果比较差异均有统计学意义(P=0.002)。末次随访复查X线片无关节再脱位, 术后患者疼痛较术前显著缓解, 生活评价及关节功能较术前显著提高。结论小切口下采用桡侧腕屈肌腱部分转位重建第一腕掌关节背侧韧带复合体及前斜韧带, 可提高关节稳定性, 缓解症状, 改善关节功能, 创伤小, 值得临床推广应用。Objective To investigate the clinical efficacy of partial transposition of flexor carpi radialis tendon for multiple ligament reconstruction through a small incision in the treatment of first carpometacarpal joint dislocation.Methods From November 2019 to August 2022,7 patients with dislocation of the first carpometacarpal jointweretreated by cutting 1/2 of the flexor carpi radialis tendon and transposing it to reconstruct the dorsal ligament complex and anterior oblique ligament of the first carpometacarpal joint.After surgery,functional exercise was guided,and regular follow-up was conducted to compare the pain,daily life assessment,and joint function before and after treatment.Results All the patients were follow-up for 3 to 36 months,with an average of(14.7±12.0)months.Pain was evaluated using the visual analogue scale(VAS),with a preoperative score of 6.9±0.7 and the last follow-up of 1.0±1.3.The daily living condition was evaluated using Quick DASH score,with a preoperative score of 49.7±12.0 and the last follow-up of 11.4±7.2.The joint function was evaluated using the Krimmer score,with a preoperative score of 45.7±13.7 and the last follow-up of 84.3±6.7.There were statistically significant differences in the results of preoperative and the last follow-up(P=0.002).At the last follow-up,there was no re-dislocation of the joint on the X-ray film.The postoperative pain of the patient was significantly relieved compared to that before the operation,and the life evaluation and joint function were significantly improved compared to that before the operation.Conclusion The application of partial transposition of flexor carpi radialis tendon through a small incision to reconstruct the dorsal and anterior oblique ligaments of the first carpometacarpal joint can improve joint stability,alleviate symptoms,improve joint function,and have minimal trauma,which is worthy of clinical application.

关 键 词：腕掌关节 脱位 桡侧腕屈肌腱 韧带重建 肌腱转位 

分 类 号：R658[医药卫生—外科学]