第一腕掌关节骨关节炎的治疗策略

Treatment strategy of first carpometacarpal joint osteoarthritis

第一腕掌关节是手部骨关节炎(osteoarthritis,OA)的好发部位,仅次于远侧指间关节,在人群中的总体发病率为7%~15%[1].绝经后的女性人群中,影像学证实第一腕掌关节骨关节炎的发病率高达25%〜36%,其中1/3存在临床症状[2-3]。患者主要表现为拇指根部疼痛,活动受限以及进展的拇指序列畸形。

The first carpometacarpal joint is the most common site of osteoarthritis in the hand.The overall incidence is 7%-15%in the population.Its main symptoms include pain at the base of the thumb,limited range of motion,and progressive deformity of the thumb.Eaton and Glickel radiographic staging system is widely used in clinic,which divides first carpometacarpal joint osteoarthritis into four stages according to the carpometacarpal joint space,range of joint dislocation,and bony change.Patients with mild symptoms in stage I and II can wear braces to increase stability and reduce mechanical stress.Patients of stage II to stage IV,who remain symptoms despite conservative treatment,should be treated by operation.Arthroscopic synovectomy,ligament reconstruction,or wedge osteotomy of metacarpal base is recomme nded in stage II.Ligament reconstructio n ten don interposition,tightrope ligament reconstruction,or carpometacarpal arthrodesis could be performed in stage III.Ligament reconstruction tendon interposition,or tightrope ligament reconstruction is recommended in stage IV.