部分拇长展肌腱或桡侧腕屈肌腱转位悬吊在第一腕掌关节成形术中的临床研究  

Clinical study on partial transfer and suspension of abductor pollicis longus tendon or flexor carpi radialis tendon in first carpometacarpal arthroplasty

作　　者：俞高翔 蔡晓明[1] 潘佳栋[1] 王欣[1] Yu Gaoxiang;Cai Xiaoming;Pan Jiadong;Wang Xin(Department of Hand Surgery,Ningbo Sixth's Hospital,Ningbo Zhejiang,315040,China)

机构地区：[1]宁波市第六医院手外科,浙江宁波315040

出　　处：《生物骨科材料与临床研究》2024年第6期31-34,44,共5页Orthopaedic Biomechanics Materials and Clinical Study

基　　金：宁波市重大科技任务攻关项目(2022Z146);宁波市医疗卫生高端团队重大攻坚项目(2022020506);宁波市鄞州区科技局项目(2021AS0026)。

摘　　要：目的比较采用部分拇长展肌腱和部分桡侧腕屈肌腱转位的两种悬吊技术,在第一腕掌关节成形中的临床效果。方法回顾性分析2019年5月至2023年10月采用拇长展肌腱(11例)与桡侧腕屈肌腱(20例)悬吊联合大多角骨切除术治疗第一腕掌关节炎(EatonⅡ-Ⅳ期)患者的临床资料。统计患者的手术时间;记录术后手功能评价指标,包括视觉疼痛模拟评分(visual analog scale,VAS)、握力、捏力、第一腕掌关节有效活动度评分(Kapandji),患者自我功能评价表(disabilities of the arm,shoulder and hand,DASH);比较手术后第一掌骨与舟骨间隙以评价手术疗效。结果拇长展肌腱悬吊术组随访13~26个月,平均(18.09±4.57)个月;桡侧腕屈肌腱悬吊术组随访12~26个月,平均(20.05±3.89)个月。拇长展肌腱悬吊术组的手术时间短于桡侧腕屈肌腱悬吊术组,两组比较差异有统计学意义(P<0.05)。两组术后12个月的VAS评分较术前降低,握力及捏力较术前提高,Kapandji评分较术前增加,DASH评分较术前降低,差异有统计学意义(P<0.05)。但两组间术后12个月VAS评分、握力、捏力、Kapandji评分、DASH评分比较,差异均无统计学意义(P>0.05)。两组间第一掌骨与舟骨间隙比较,差异无统计学意义(P>0.05)。结论大多角骨切除后,采用部分拇长展肌腱转位或部分桡侧腕屈肌腱转位的悬吊术均能有效减轻患者疼痛并改善第一腕掌关节功能,两者治疗效果无统计学差异。但是,前者手术操作相对简单,手术用时短,可作为第一腕掌关节成形术时肌腱悬吊的优先选择。Objective To compare the clinical outcomes of two suspension techniques,utilizing partial abductor pollicis longus(APL)and partial flexor carpi radialis(FCR)tendon transfer in trapeziometacarpal arthroplasty.Methods A retrospective analysis was conducted on patients treated between May 2019 and October 2023 for trapeziometacarpal osteoarthritis(Eaton stageⅡ-Ⅳ)with trapeziectomy combined with either APL(11 cases)or FCR(20 cases)tendon suspension.The operation time was recorded,and postoperative hand function was assessed using visual analog scale(VAS)scores,grip strength,pinch strength,Kapandji scores for range of motion at the trapeziometacarpal joint,and the Disabilities of the Arm,Shoulder and Hand(DASH)questionnaire.Postoperative trapeziometacarpal joint stability was evaluated by comparing the distance between the first metacarpal base and the distal scaphoid articular surface.Results The APL group was followed-up for 13-26 months,with an average of(18.09±4.57)months.The FCR group was followed-up for 12-26 months,with an average of(20.05±3.89)months.The operation time of APL group was shorter than the FCR group,with a significant difference(P<0.05).Both groups showed significant postoperative improvements at 12 months in VAS scores,grip and pinch strength,Kapandji scores,and DASH scores(all P<0.05),indicating functional recovery.No significant differences were found between the two groups at 12 months postoperatively in VAS scores,grip and pinch strength,Kapandji scores,and DASH scores(all P>0.05).The trapeziometacarpal joint space between the first metacarpal base and distal scaphoid articular surface showed no significant changes between the two groups(P>0.05).Conclusion Both APL and FCR tendon transfers effectively alleviate pain and improve trapeziometacarpal joint function following trapeziectomy,with no significant difference in treatment efficacy.However,the APL transfer technique offers a simpler operative approach and shorter surgical duration,suggesting that may be the preferred choice for ten

关 键 词：第一腕掌关节 关节炎 拇长展肌腱 关节成形 

分 类 号：R684.3[医药卫生—骨科学]