第五腕掌关节创伤性关节炎患者的关节成型术治疗

Arthroplasty for traumatic arthritis of the fifth carpometacarpal joint

目的：总结分析腕掌关节成型术治疗第五腕掌关节（ carpometacarpal，CMC ）创伤性关节炎的疗效。方法2006年1月至2011年1月，利用 Scheker 腕掌关节成型术治疗第五腕掌关节创伤性关节炎患者6例，男5例，女1例；左侧1例，右侧5例；年龄（45±10）（31～55）岁。分别记录术前和术后的临床和影像学结果，检查指标包括握力、掌指关节活动度及第五掌骨高度。并在手术前后采用疼痛视觉模拟评分（ VAS ）来评估主观的疼痛程度。结果6例均随访（17.6±10.4）（9～36）个月。腕掌关节成型术后，植骨融合时间（6.2±0.8）（5～7）周。患侧握力术前为（33.6±12.2） kg，术后握力改善为（44.2±12.7） kg，术前与术后比较差异有统计学意义（ t＝-4.566，P＝0.006）。患侧小指掌指关节活动度术前为（88.5±3.6）°，术后为（87.8±2.6）°，术前与术后比较差异无统计学意义（ t＝1.195，P＝0.286）。患侧第五掌骨高度术前为（53.7±4.0） mm，术后为（52.3±3.6） mm，术前与术后比较差异无统计学意义（ t＝1.754，P＝0.140）。术后疼痛改善， VAS由术前平均2.8，降至术后0.2。结论 Scheker腕掌关节成型术是治疗第五腕掌关节创伤性关节炎的有效方法，可以改善握力，并消除腕尺侧疼痛。

Objective To summarize and analyze the clinical outcomes of arthroplasty for traumatic arthritis of the 5th carpometacarpal （ CMC ） joint. Methods From January 2006 to January 2011, 6 patients were identiifed with traumatic arthritis of the 5th CMC joint. There were 5 males and 1 female, with a mean age of （ 45±10 ） years old （ range;31-55 years ）. One case was on the left side, and the other 5 cases were on the right side. All patients underwent Scheker CMC arthroplasty. The clinical and radiographic outcomes were respectively recorded preoperatively and postoperatively, including the grip strength, the 5th metacarpophalangeal （ MCP ） range of motion （ ROM ） and the 5th metacarpal height. The Visual Analogue Scale （ VAS ） was used to assess the subjective degree of pain before and after the operation. Results All patients were followed up for an average period of （ 17.6±10.4 ） months （ range;9-36 months ）. The osteotomy union were obtained after an average period of （ 6.2±0.8 ） weeks （ range;5-7 weeks ） after the CMC arthroplasty. The grip strength was improved from （ 33.6±12.2 ） kg before the operation to （ 44.2± 12.7 ） kg after the operation, and the differences were statistically signiifcant （ t=-4.566, P=0.006 ）. The ROM of the 5th MCP joint of the affected little ifnger was （ 88.5±3.6 ）° before the operation and （ 87.8±2.6 ） ° after the operation, and the differences were not statistically significant （ t=1.195, P=0.286 ）. The 5th metacarpal height was （ 53.7± 4.0 ） mm before the operation and （ 52.3±3.6 ） mm after the operation, and the differences were not statistically significant （ t=1.754, P=0.140 ）. The VAS scores were improved from 2.8 points preoperatively to 0.2 points postoperatively on average. Conclusions Scheker CMC arthroplasty is an effective method for traumatic arthritis of the 5th CMC joint, with the grip strength improved and the pain of the ulnar-sided wrist relieved.