改良桡侧腕屈肌腱悬吊术在治疗第一腕掌关节骨性关节炎中的应用

Clinical application of modified flexor carpi radialis tendon suspension in the treatment of the first carpometacarpal arthritis

目的探讨大多角骨切除、桡侧腕屈肌腱悬吊联合挤压钉固定治疗第一腕掌关节骨性关节炎的临床疗效。方法回顾性分析自2014年5月至2019年10月采用大多角骨切除、桡侧腕屈肌腱桡侧半悬吊联合挤压钉治疗原发性Eaton Ⅱ、Ⅲ、Ⅳ期第一腕掌关节骨性关节炎的11例患者的资料。比较手术前后从X线片测得的第一掌骨基底与舟骨远侧关节面间距、视觉模拟评分(visual analogue scales,VAS)、第一腕掌关节有效活动度评分(Kapandji评分)、握力、捏力。采用配对t检验进行数据的统计学分析。结果术后11例患者均获得随访,时间12~24个月,平均(16.0±3.3)个月。末次随访时VAS评分较术前显著降低,Kapandji评分较术前显著升高,握力较术前显著增加,捏力较术前显著增加(P<0.05)。第一掌骨基底与舟骨远侧关节面间距较术前无显著变化,差异无统计学意义(P>0.05)。结论大多角骨切除、桡侧腕屈肌腱桡侧半悬吊联合挤压钉固定治疗Eaton Ⅱ、Ⅲ、Ⅳ期第一腕掌关节骨性关节炎,可以有效减轻第一腕掌关节疼痛,并改善拇指功能和力量,防止第一掌骨下沉,术后疗效显著。

Objective To explore the clinical efficacy of trapezium excision and flexor carpi radialis(FCR)tendon suspension combined with press-fit bolt in the treatment of the first carpometacarpal(CMC)arthritis.Methods Retrospective analysis of 11 cases with the first CMC arthritis of primary EatonⅡ,Ⅲ,Ⅳstage treated by trapezium excision and FCR tendon suspension combined with press-fit bolt from May 2014 to October 2019 was performed.The distance between the base of the first metacarpal bone and the distal articular surface of the scaphoid bone in the anterior and posterior X-ray film,visual analogue scales(VAS),Kapandji score,grip and pinch strength were compared before and after operation.The results preoperative and postoperative were statistically analyzed by paired t-test.Results All the 11 patients were follow-up for 12 to 24 months with an average of(16.0±3.3)months.At the last follow-up,the VAS decreased significantly,Kapandji score increased significantly,grip strength increased significantly,and pinch strength increased significantly(P<0.05).There was no significant difference in the distance between the base of the first metacarpal bone and the distal articular surface of the scaphoid bone(P>0.05).Conclusion The treatment of the first CMC arthritis of EatonⅡ,Ⅲ,Ⅳstage with trapezium excision and suspension of radial half of FCR tendon combined with press-fit bolt can effectively relieve the pain of the first CMC joint,improve the function and strength of the thumb and prevent the sinking of the first metacarpal bone.The clinical efficacy is remarkable.