应力位影像评估拇指腕掌关节松弛性的研究及意义

The study of stress radiograph in the evaluation of trapeziometacarpal joint laxity

目的应用应力位影像技术评估拇指腕掌关节松弛性，并评价其一致性。方法选择66例无拇指腕掌关节外伤史、骨关节炎史和手术史的患者进行应力位投照，由两名手外科医生对每张图片分别测量两个参数：第1掌骨基底桡偏宽度（RS），第1掌骨基底关节面的宽度（Aw），并计算两者之间比值（R），用独立样本t检验评估男性、女性之间的关系，用配对t检验评估测量者之间数据的一致性。结果RS的平均测量值为（4．27±1．83）nlln（1～8mm），AW的平均测量值为（13．52±1．89）mm（10～17．3mm），平均比率（R）为（0．32±0．11），性别之间有显著差异（P=-0．026），女性桡偏率比男性显著高，测量者之间数据无明显差异（P=-0．23）。结论应力位拇指腕掌关节影像可以评估关节松弛性，一致性比较高。

Objective Modified stress-positioned radiograph technique was used to measure carpometacarpal joint laxity with its consistence evaluated. Method Stress -positioned radiographs were obtained from 66 patients whose carpometacarpal joint had no trauma, arthritis and surgeric history. Two measurements were performed by two hand surgeons： the width of radial subluxation of the first metacarpal base and the width of the first metacarpal articular surface; the ratio between them was calculated. T-test were performed to assess the reliability and difference between male and female. Result The average of the RS measurement is （4.27±1.83） mm （range 1-8mm）and the AW measurement is （13.52±1.89）mm （range 10-17.3 mm）. The average RS/AW subluxation ratio is （0.32±0.11）. Women showed greater value of the ratio than men （P=-0.026）. The measurements of two hand surgeon showed high consistence （P=0.23）. Conclusion The stress-positioned radiograph could evaluate joint laxity of the trapeziometacarpal articulation with high consistence.