保留近极的大多角骨部分切除联合腱球填塞治疗第1腕掌关节炎

Application of hemi excision of trapezium combined with tendon ball tamponade in the treatment of first carpometacarpal arthritis

目的探讨保留近极的大多角骨部分切除联合腱球填塞治疗EatonⅡ、Ⅲ期第1腕掌关节炎的临床疗效。方法回顾性分析2013年3月至2018年10月采用保留近极的大多角骨部分切除联合腱球填塞治疗12例原发性第1腕掌关节炎患者资料,均为女性患者,年龄(55±2.8)岁(范围,48~61岁);左侧拇指3例,右侧拇指9例;根据术前影像学检查及Eaton分期,Ⅱ期8例,Ⅲ期4例。术后根据第1腕掌关节成形高度指数评价第1掌骨下沉率,评价手术前后视觉模拟评分(visual analogue scales,VAS)、上肢功能障碍评分(disability of the arm,shoulder and hand,DASH)及握力、捏力的变化情况。采用t检验和方差分析行统计学处理。结果12例患者均获得随访,随访时间(12±4.8)个月(范围,6~17个月)。末次随访,VAS评分[(1.2±1.0)分]较术前[(6.3±1.5)分]明显降低(t=13.4,P=0.0001),DASH评分[(26.2±9.6)分]较术前[(48.9±13.0)分]明显下降(t=5.7,P=0.0001),握力[(25.5±6.8)kg]较术前[(15.0±2.9)kg]明显增高(t=7.3,P=0.0001),捏力[(3.2±0.8)kg]较术前[(2.1±0.4)kg]增高(t=3.6,P=0.0045);以上指标分别与术前相比,差异均有统计学意义。末次随访时,第1腕掌关节成形高度指数为0.299±0.022,与术前(0.306±0.021)和术后(0.313±0.024)相比,差异无统计学意义(F=1.337,P=0.276),表明术后第1掌骨无明显下沉趋势。术后2例患者出现切口红肿,有渗出液体,考虑为关节内手术局部血肿未能完全吸收,经多次换药后红肿消退。结论对于EatonⅡ、Ⅲ期第1腕掌关节炎采用保留近极的大多角骨部分切除,保留近端关节面,同时联合腱球填塞治疗,能有效减少第1掌骨下沉率,改善及减轻第1腕掌关节功能和疼痛,疗效显著。

Objective To describe the treatment of the first carpometacarpal arthritis in EatonⅡ,Ⅲcombining the hemi excision of trapezium with tendon ball and evaluate its clinical efficacy.Methods Data of patients with the first carpometacarpal arthritis who were treated by hemi excision of trapezium and tamponade of the tendon ball from March 2013 to October 2018 were retrospectively analyzed.Twelve patients were all females with an average age of 55±2.8 years(range,48-61 years).There were 3 cases of left thumbs and 9 cases of right.The study was only researched with primary osteoarthritis patients,preoperative imaging Eaton stages,including 8 cases inⅡstage,4 cases inⅢstage.Postoperative X-ray examination was performed,and the subsidence rate of the first metacarpal bone was evaluated according to height of arthroplasty.Preoperative and postoperative pain was evaluated according to visual analogue scales(VAS)score and DASH score.Preoperative and postoperative finger movement was evaluated according to the changes in preoperative and postoperative grip and pinch force.Results The average follow-up period was 12±4.8 months(range,6-17 months).The mean score of VAS after operation was 1.2±1.0 which was lower than 6.3±1.5 before operation(t=13.4,P=0.0001);DASH score after operation was 26.2±9.6 which was lower than 48.9±13.0 before operation(t=5.7,P=0.0001);Grip force after operation was 25.5±6.8 kg which was higher than 15.0±2.9 kg before operation(t=7.3,P=0.0001);Pinch force after operation was 3.2±0.8 kg which was higher than 2.1±0.4 kg before operation(t=3.6,P=0.0045),and all of these four above data has statistic difference.At the latest postoperative follow-up,the height index of arthroplasty was 0.299±0.022,and there was no significant change(F=1.337,P=0.276)when compared with 0.306±0.021 before surgery and 0.313±0.024 after surgery.After the operation,2 patients presented with incision redness and swelling and exudation.It was considered that local hematoma in the intra-articular operation could not be completely absorbed.After several dressing changes,the redness and swelling subsided and the exudation was controlled.Conclusion Preserving the proximal joint surface of trapezium and tamponading tendon ball,could reduce the subsidence rate of the first metacarpal bone and alleviate the pain of the first carpometacarpal joint,thus may effectively improve the joint function.It has a significant effect on the treatment of EatonⅡ,Ⅲstage of the first carpometacarpal arthritis.