桡侧腕长伸肌腱重建先天性第一腕掌关节发育不良

Reconstruction of congenital first carpometacarpal dysplasia with extensor carpi longus radialis tendon

目的介绍一种修复ⅢB型拇指发育不良腕掌关节不稳的方法,采用桡侧腕长伸肌腱的一半重建第一腕掌关节,评价该手术修复ⅢB型拇指发育不良的疗效。方法对4例患儿的单侧拇指发育不良进行回顾性临床研究。均为ⅢB型拇指发育不良,且X线片示第一掌骨长度接近正常。手术采用桡侧腕长伸肌腱的一半重建第一腕掌关节韧带。后期行拇对掌和伸拇功能重建。术后通过测量拇指桡侧外展、掌侧外展、伸拇和改良Kapandji量表评估临床疗效。结果术后随访1.5~3.0年,平均2.1年。术后拇指桡侧外展和掌侧外展的平均角度分别为78°和41°,患儿拇指主动桡侧外展和掌侧外展功能获得改善。术后平均拇指伸直度为-5°,接近正常拇指。4例患儿术后的第一腕掌关节均稳定。Kapandji评分显示术后所有儿童的拇对掌功能均有所改善。结论对于第一掌骨长度接近正常的ⅢB型拇指发育不良患儿,使用桡侧腕长伸肌腱的一半重建第一腕掌关节韧带结合肌腱移位的分期手术可能是一种有效的治疗策略。

Objective To introduce a method that the first carpometacarpal joint ligament was reconstructed with half of the extensor carpi radialis longus tendon to repair the instability of carpometacarpal joint in typeⅢB thumb dysplasia and to evaluate the clinical efficacy of this operation.Methods A retrospective clinical study was conducted on 4 children with unilateral thumb dysplasia.All the cases were typeⅢB thumb dysplasia,and the X-ray film showed that the length of the first metacarpal bone was close to normal.Surgery procedure:the ligament of the first carpometacarpal joint was reconstructed with half of the extensor carpi radialis longus tendon.In the later stage,thumb opposition and thumb extension were reconstructed.The clinical efficacy was evaluated by measuring the radial abduction,palmar abduction,thumb extension and modified Kapandji scale.Results The postoperative follow-up ranged from 1.5 to 3.0 years,with an average of 2.1 years.The average angles of radial abduction and palmar abduction of the thumb were 78°and 41°respectively after operation,and the active radial abduction and palmar abduction of the thumb were improved.The average extension of thumb after operation was-5°,close to normal thumb.The first carpometacarpal joint of 4 children was stable after operation.Kapandji score showed that the function of thumb opposition was improved in all children after operation.Conclusion For children with typeⅢB thumb dysplasia whose first metacarpal bone length is close to normal,staged operation of reconstructing the first carpometacarpal joint ligament with half of the extensor carpi radialis longus tendon and tendon displacement may be an effective treatment strategy.