关节融合术治疗拇指第一腕掌关节炎的初步疗效分析

Arthrodesis for treatment of first carpometacarpal joint arthritis： a preliminary report

目的探讨关节融合术治疗拇指第一腕掌关节炎的临床疗效。方法自2010年8月至2015年1月，应用关节融合术治疗第一腕掌关节骨性关节炎患者29例，男5例，女24例；年龄45—71岁，平均58岁。左侧拇指9例，右侧拇指20例。术前根据影像学Eaton—Glickel分期：Ⅱ期4例，Ⅲ期25例。所有病例均用微型钢板固定，6例融合时行自体桡骨远端移植。术后定期复查x线片观察腕掌关节融合情况及大多角骨周围是否出现关节炎，分别测量各组握力、指间捏力、活动度及痛觉视觉模拟评分（visual analogue scale，VAS），并对上述结果进行统计学分析。结果29例术后平均随访25．2个月。第一腕掌关节融合率达到100％，握力和指间捏力较术前增加，VAS评分较术前下降，差异均有统计学意义。4例出现大多角骨周围关节炎，但患者满意度较高，活动拇指VAS评分平均0．7。结论关节融合术是治疗第一腕掌关节炎的有效方法，孤立的第一腕掌关节炎的老年患者也存在关节融合的指征；虽然术后出现大多角骨周围关节炎，但患者满意度较高，无需继续治疗。

Objective To evaluate the clinical efficacy of arthrodesis for treatment of first carpometacarpal joint arthritis. Methods From August 2010 to January 2015, 29 patients underwent arthrodesis of the first carpometacarpal joint for arthritis of the thumb. There were 5 males and 24 females with an average age of 58 years （range, 45 to 71 years）. The left side was involved in 9 thumbs and right side in 20 thumbs. According to Eaton-Glickel classification, 4 thumbs belonged to stage Ⅱ , and 25 thumbs to stage m. Joint fusion was achieved by micro-plate fixation in all the cases, while 6 patients had autologous bone graft from the distal radius as well. Pain level （visual analogue scale, VAS）, grip strength, tip pinch strength and range of motion were recorded. The post-operative X-ray and peri-trapezium arthritis were observed. The results were statistically analyzed. Results All patients were follow-up for 6 months to 4 years, with an average of 25.2 months. Joint fusion rate was 100%. Grip strength and tip pinch strength improved after the surgery. VAS was significantly reduced. The differences were statistically significant. There were 4 cases of postoperative osteoarthritis mostly around the comer of the trapezium, but patient satisfaction was high. The mean VAS was 0.7 when moving thumbs. Conclusion Arthrodesis is an effective method for the treatment of first carpometacarpal joint arthritis. It is also indicated in isolated first carpometacarpal arthritis in elderly patients. Despite arthritis around the trapezium, patient satisfaction is high, without the need for further treatment.