关节镜下微创治疗第一腕掌骨关节炎

Arthroscopic Minimally Invasive in the Treatment of the First Carpal Metacarpal Arthritis

目的探讨关节镜下微创治疗第一腕掌骨关节炎的临床效果。方法对16例腕掌骨关节炎应用1．9mm的关节镜，采用1R及1U入路进行清理，同时在第一、二掌骨基底背侧作3cm横切口，于第二掌骨基底打入微型缝合锚，锚钉缝线经桡动、静脉背支及拇长伸肌腱深面穿过，采用悬吊及紧缩缝合第一腕掌关节桡背侧关节囊，行关节囊成形术，矫正因骨关节炎造成的第一腕掌关节半脱位。结果术后随访18～24个月，本组优5例，良7例，可3例，差1例，优良率75％；改良MAYO评分术前（26．88±13。08）分，术后（82．50±12．25）分，差异有统计学意义（P〈0．01）。x线片示第一腕掌关节对位关系良好，无脱位等并发症发生。结论关节镜下微创治疗第一腕掌骨关节炎具有术中操作简单、术后恢复良好的优势。

Objective To discuss the effectiveness of arthroscopic minimally invasive in the treatment of the first carpal metacarpal arthritis. Methods 16 patients with the first carpal metacarpal arthritis were cleaned through IR and 113 entrance by 1.9 mm arthroseope. At the same time, a 3 cm transverse incision was made on the first and the second dorsal metacarpal base and the mini suture anchors were fixed at the second metacarpal base via through the radial artery and the deep surface of extensor pollicis longus mucscle tenodon, with use of suspension and tightening suture of the dorsalis joint capsule of the first carpometacarpal joint, capsuloplasty was made to correct the first earpometacarpal joint subluxation. Results All patients were followed up for 18 to 24 months ; excellent in 5 cases, good in 7 cases, general in 3 cases and poor in 1 case, and the fine rate was 75% ; the mean score evaluated by modified MAYO was preoperative （26. 88 ± 13.08） and （82.50 ± 12.25 ） after the surgery, there was significant difference （P 〈 0. 01 ）; X-ray showed the first carpometacarpal joint of the relationships was good and not dislocated. Conclusion Minimally invasive arthroscopic debridement and suspension arthroplasty in the treatment of the first carpal metacarpal arthritis has such advantages as being minimally invasive, simple, and rapid recovery., but further accumulation of cases is needed.