拇长展肌腱束转位重建多韧带手术治疗第1腕掌关节脱位

Reconstruction of the ligament surgery for dislocation of the first carpometacarpal joint by transposition of extensor pollicis tendon band

目的报道拇长展肌腱束转位重建第1腕掌关节后斜韧带及背桡侧韧带手术治疗第1腕掌关节脱位的临床疗效。方法自2015年1月至2019年12月,对5例第1腕掌关节脱位患者实施关节复位、克氏针牵引固定及拇长展肌腱束重建第1腕掌关节后斜韧带和背桡侧韧带手术,术后4周去除外固定并拔除克氏针开始功能锻炼。根据X线片、拇指关节活动范围(rangeofmotion,ROM)评价手术效果。结果术后随访5~12个月(平均8个月)。末次随访复查X线片无关节再脱位;ROM检测,4例屈伸、收展活动恢复正常,1例对掌受限。结论采用拇长展肌腱束转位重建第1腕掌关节韧带,可恢复关节稳定性,改善功能。

Objective To investigate the clinical effect of the first carpal metacarpophalangeal and dorsal radial ligament reconstruction with long hallus abdominis tendon flap in the treatment of the first carpal metacarpal dislocation.Methods From January 2015 to December 2019,five patients with the first carpalmetacarpal joint dislocation were treated with embole,Kirschner wire traction and fixation for arthroplasty,and the posterior oblique ligament and dorsal radial side of the first carpal-metacarpal joint were reconstructed with the long abdominis tendon flap ligament.Four weeks after operation,the fixation was removed and the Kirschner wire was removed to begin functional exercise.The operation effect was evaluated according to the X-ray films and the range of motion(ROM)of the thumb joint.Results Postoperative follow-up was 5-12 months(average 8 months).The last follow-up X-rays films showed no re-dislocation.ROM test showed that flexion and extension activities returned to normal in 4 cases.And one case had restricted contralateral palms.Conclusions Reconstruction of the first carpal metacarpal ligament using the long abductor hallucis tendon flap can restore joint stability and improve function.