关节镜辅助大多角骨部分切除联合襻钢板悬吊治疗第1腕掌关节炎

Arthroscopic partial trapeziectomy and suture button suspensionplasty in the treatment of first carpometacarpal joint athrosis

目的探讨关节镜辅助大多角骨部分切除联合襻钢板悬吊治疗EatonⅡ、Ⅲ期第1腕掌关节炎的临床疗效。方法回顾性收集2020年1月至2022年6月于深圳市第二人民医院诊治的EatonⅡ、Ⅲ期第1腕掌关节炎患者15例(16侧),男5例(双侧1例)、女10例,年龄为(56.7±6.4)岁(范围46~75岁)。术前X线片示关节间隙狭窄、周围骨赘形成,并向桡背侧脱位。行关节镜下部分大多角骨切除,采用高强线及指骨钢板自制襻钢板悬吊固定第1掌骨。记录重返工作时间,比较术前和末次随访时第1腕掌关节位置和掌骨下沉情况,疼痛视觉模拟评分(visual analogue scale,VAS)、拇指Kapandji评分、上肢功能评定表评分(disabilies of the arm,shoulder,and hand,DASH)及捏力、握力。结果15例随访时间为(19.6±6.3)个月(范围11~36个月)。术后即刻X线片证实腕掌关节均得到复位,第1掌骨高度维持满意。患者术后恢复日常活动时间为(18.69±3.70)d,恢复正常工作时间为(24.63±4.91)d。VAS由术前(6.56±1.15)分降至末次随访1.00(0.75,1.25)分,Kapandji评分由(8.00±0.82)分提升至8.00(7.25,9.00)分,DASH评分由(24.06±3.19)分降至4.00(3.00,5.00)分,除Kapandji评分外的差异均有统计学意义(Z=-4.905,P<0.001;Z=-0.121,P=0.905;Z=-4.846,P<0.001)。握力由术前16.4(14.13,18.68)kg提升至末次随访的(26.14±3.27)kg,捏力由(1.70±0.35)kg提升至(3.58±0.91)kg,差异有统计学意义(Z=-4.617,P<0.001;t=-7.669,P<0.001)。结论关节镜辅助大多角骨部分切除联合襻钢板悬吊第1掌骨治疗EatonⅡ、Ⅲ期第1腕掌关节炎创伤小、恢复快、并发症少,可保留腕掌关节活动度、维持关节稳定,能够有效缓解疼痛、改善功能。

Objective To analyze the clinic effects of arthroscopic partial trapeziectomy and suture button suspensionplasty in the treatment of first carpometacarpal joint(CMCJ)Eaton stage Ⅱ/Ⅲ arthrosis.Methods A retrospective study was conducted on a total of 15 cases(16 hands)of patients including 5 males(1 bilateral)and 10 females with CMCJ stage Ⅱ/Ⅲ arthrosis who underwent surgical treatment at the first affiliated hospital of Shenzhen university from January 2020 to June 2022,with mean age of 56.7±6.4 years(range,46-75 years).The duration from pain to treatment was 7.8±3.2 months(range,4-14 months).X-ray showed narrowing of CMCJ with osteophytes and distal radial subluxation.All the patients were treated with arthroscopic partial trapeziectomy and suture button suspensionplasty.The preoperative and last postoperative follow-up radiographs,visual analogue scale(VAS),thumb's Kapandji scores,disabilies of the arm,shoulder,and hand(DASH)scores,grip and pinch strength and time to return to work were compared.Results All cases were followed up for 19.6±6.3 months(range,11-36 months).The postoperative X-ray showed all the CMCJs were reduced with a normal height of first metacarpal.The mean time for patients to return to their daily activities was 18.69±3.70 d and the mean time to return to work was 24.63±4.91 d.The average VAS score decreased from 6.56±1.15 preoperatively to 1.00(0.75,1.25).The preoperative Kapandji's score was 8.00±0.82 and the postoperative Kapandji's score was 8.00(7.25,9.00).The average DASH values improved from 24.06±3.19 to 4.00(3.00,5.00).The were significant differences except for Kapandji score(Z=-4.905,P<0.001;Z=-0.121,P=0.905;Z=-4.846,P<0.001).The mean grip and pinch strength showed improvement from an average of 16.4(14.13,18.68)kg and 1.70±0.35 kg to 26.14±3.27 kg and 3.58±0.91 kg with significant difference(Z=-4.617,P<0.001;t=-7.669,P<0.001).Conclusion Arthroscopic partial trapeziectomy and suture button suspensionplasty is a minimally invasive surgery for the treatment of first CMCJ Eaton stage Ⅱ/Ⅲ arthrosis.By this technique,the patients'existing instability and pain problems can be solved.