大多角骨切除加改良拇长展肌悬吊关节成形术治疗第一腕掌关节炎

Application of trapeziectomy combined with modified abductor pollicis longus suspension arthroplasty for the treatment of the first carpometacarpal joint osteoarthritis

目的评价大多角骨切除加改良拇长展肌悬吊关节成形术治疗第一腕掌关节炎的临床疗效。方法自2017年11月至2020年4月,我们对7例第一腕掌关节炎患者行大多角骨切除加改良拇长展肌悬吊关节成形术。术后1、3、6个月随访患者拇指活动度、疼痛评分、上肢功能障碍评分和第一腕掌关节高度。结果术后随访8~47个月,平均28.6个月。拇指活动度Kapandji评分术前(4.67±2.40)分,术后3个月时(8.56±1.13)分;VAS评分术前(7.11±2.42)分,最后一次随访时(1.44±0.88)分。上肢功能障碍评分Quick-DASH评分术前(61.88±16.87)分,最后一次随访时(24.49±14.08)分。第一腕掌关节高度术前(8.66±0.70)mm,术后3个月时(6.36±1.74)mm。术后3个月时第一掌骨近端移位水平(27.19±17.40)%。结论大多角骨切除加改良拇长展肌悬吊关节成形术治疗第一腕掌关节炎可缓解拇指疼痛、改善拇指活动度、显著改善上肢功能,是一种值得推荐的有效治疗方法。

Objective To evaluate the clinical efficacy of trapeziectomy combined with modified abductor pollicis longus suspension arthroplasty for the treatment of the first carpometacarpal joint osteoarthritis.Methods From November 2017 to April 2020,7 patients with the first carpometacarpal joint osteoarthritis underwent trapeziectomy combined with modified abductor pollicis longus suspension arthroplasty.The thumb mobility,pain score,upper limb dysfunction score and the height of the first carpometacarpal joint were followed up at 1,3 and 6 months after operation.Results The patients were follow-up for 8 to 47 months,with an average of 28.6 months.The Kapandji score of thumb mobility was(4.67±2.40)before operation and(8.56±1.13)3 months after operation.The VAS was(7.11±2.42)before operation and(1.44±0.88)at the last follow-up.The upper limb dysfunction score Quick-DASH score was(61.88±16.87)before operation and(24.49±14.08)at the last follow-up.The height of the first carpometacarpal joint was(8.66±0.70)mm before operation and(6.36±1.74)mm 3 months after operation.The level of proximal displacement of the first metacarpal bone at 3 months after operation was(27.19±17.40)%.Conclusion The application of trapeziectomy combined with modified abductor pollicis longus suspension arthroplasty for the treatment of the first carpometacarpal joint osteoarthritis can alleviate thumb pain,improve thumb mobility and significantly improve upper limb function.It is an effective treatment method worthy of recommendation.