拇指腕掌关节前斜韧带与背桡韧带两种重建方式的生物力学比较

Biomechanical comparison of anterior oblique ligament versus dorsal radial ligament reconstruction of the trapeziometacarpal joint

目的拇指腕掌关节炎患者在大多角骨切除后，行拇指腕掌关节背桡韧带重建或前斜韧带重建，比较两种韧带重建方式的抗轴向短缩能力，确定何种方式更为稳定。方法解剖成人男性尸体新鲜手标本20例，切除大多角骨，取其半束桡侧腕屈肌腱，重建背桡韧带10例，重建前斜韧带10例，在生物力学机上进行压力测试，测量第一掌骨下沉10mm所需的载荷量，观察何种韧带重建方式抗轴向短缩能力强。结果大多角骨切除后，重建背桡韧带标本的第一掌骨下沉10mm所需最大载荷为（67．67±7．98）N，重建前斜韧带标本的为（77．11±8．25）N，两组数据差异有统计学意义（P〈0．05）。结论拇指腕掌关节在大多角骨切除后，用桡侧腕屈肌腱重建腕掌关节韧带，采用前斜韧带更为稳定，应首选重建该韧带。

Objective To compare the axial shortening resistance of anterior oblique ligament and dorsal radial ligament reconstruction of trapeziometacarpal joint after trapezium excision for the patients with osteoarthritis of trapeziometacarpal joint, and to determine which method was more stable. Methods Twenty cases of male adult flesh cadaver hand specimens were dissected. After the trapezium excision, ten cases of anterior oblique ligament and ten cases of dorsal radial ligament were reconstructed using half bundle of flexor carpi radialis tendon. Biomechanical testing was performed to obtain maximum load when the first metacarpal sinking 10 mm and to determine which ligament reconstruction method yielded larger axial shortening resistance. Results After the trapezium excision, the maximum load of the dorsal radial ligament reconstruction when the first metacarpal sinking 10 mm was （67.67±7.98） N and that of the anterior oblique ligament reconstruction was （77.11±8.25） N. The difference between two groups was significant （P〈0.05）. Conclusion After the trapezium excision, anterior oblique ligament reconstruction using flexor carpi radialis tendon can achieve more stable trapeziometacarpal joint. We should reconstruct the anterior oblique ligament firstly.