韧带重建肌腱团填塞术治疗第一腕掌关节骨关节炎的疗效分析

Ligament reconstruction tendon interposition arthroplasty for first carpometacarpal joint osteoarthritis

目的：探讨韧带重建肌腱团填塞术（ligament reconstruction tendon interposition, LRTI）治疗第一腕掌关节骨关节炎的临床疗效。方法回顾性分析2008年1月至2011年1月，应用LRTI治疗19例（21拇指）第一腕掌关节骨关节炎患者资料，男1例（1拇指），女18例（20拇指）；年龄52～75岁，平均60岁；左侧8拇指，右侧13拇指。术前影像学Eaton-Glickel分期：Ⅱ期1拇指，Ⅲ期14拇指，Ⅳ期6拇指。根据术后第一掌骨向近端移位的程度，分为轻度（0～33%）、中度（34%～67%）、重度（68%～100%）三组，分别测量各组握力、指尖捏力、活动度及疼痛视觉模拟评分（visual analogue scale， VAS），并对上述结果进行统计学分析。结果19例患者均获得随访，随访时间9～28个月，平均13.9个月。影像学结果显示，术后第一掌骨向近端移位，关节成形高度由术前的（12.4±2.7）mm降至术后（5.6±1.9）mm，平均降幅达54.8%；握力由术前的（18.6±10.1）kg增至术后的（20.5±11.9）kg；指尖捏力由术前的（4.4±2.1）kg增至术后（4.5±1.9）kg，但术前的握力和指尖捏力与术后比较无差异。关节活动度改善，拇指桡侧外展由术前的55.7°±8.2°增至术后的60.6°±7.2°，掌侧外展由术前的56.7°±8.5°增至术后的63.5°±8.2°，术前与术后比较差异有统计学意义。VAS评分从术前（6.6±1.4）分降至（0.5±0.7）分。轻、中、重度移位组间指尖捏力、握力、活动度和VAS评分无差异。结论 LRTI能消除疼痛及改善拇指的活动度，但并不能有效阻止第一掌骨向近端移位，其术后平均移位幅度超过50%，但这种移位对术后临床疗效并无显著影响。

Objective To explore the clinical outcomes of Ligament reconstruction tendon interposition （LRTI） arthro-plasty for first carpometacarpal joint osteoarthritis. Methods From January 2008 to January 2011, 19 patients （21 thumbs） had surgery for thumb carpometacarpal arthritis using ligament reconstruction tendon interposition arthroplasty with flexor carpi radia-lis （FCR）. There were 1 male and 18 were females with an average age of 60 years （range, 52-75 years）;8 thumbs were on the left side and 13 thumbs on the right side. According to Eaton-Glickel classification, 1 thumb belonged to stageⅡ, 14 thumbs to stageⅢ, and 6 thumbs to stageⅣ. Pain level, grip strength, tip pinch strength, range of motion, and radiographic measurement were re-corded. According to the first metacarpal subsidence, the cases were classified in mild, moderate, and severe groups. Clinical out-comes of different group were evaluated and compared. Results All patients were followed up for 9-28 months with an average of 13.9 months. Comparision with the preoperative X-rays showed the first metacarpal had subsided 54.8% of the arthroplasty space after surgery. Grip strength improved from 18.6±10.1 kg to 20.5±11.9 kg, and tip pinch strength increased from 4.4±2.1 kg to 4.5 ± 1.9 kg after the surgery. Radial abduction increased from 55.7° ± 8.2° to 60.6° ± 7.2° and palmar abduction improved from 56.7° ± 8.5° to 63.5° ± 8.2° after the procedure. Patient pain levels （visual analogue scale, VAS） were significantly reduced, from 6.6 ± 1.4 to 0.5 ± 0.7. There was no difference of grip strength, tip pinch strength, thumbs range of motion, and VAS after LRTI in mild, moderate and severe groups. Conclusion LRTI resulted in excellent relief of pain and increase in range of motion. Howev-er, LRTI cannot sustain the arthroplasty space. Compared with the preoperative X-ray, the first metacarpal subsided more than 50%. Subsidence of the first metacarpal doesn＇t affect the pain relief, range of motion and strength improvement.