腕掌关节融合术与改良Eaton-Littler术治疗第一腕掌关节炎的疗效比较

Comparison of clinical efficacy between carpometacarpal arthrodesis and modified Eaton-Littler′s reconstruction for the treatment of the first carpometacarpal joint osteoarthritis

目的比较腕掌关节融合术与改良Eaton-Littler术治疗第一腕掌关节炎的疗效。方法回顾性分析自2007年5月至2020年11月我们采用手术治疗的25例EatonⅢ期第一腕掌关节炎患者,其中行腕掌关节融合术11例,改良Eaton-Littler术14例,对两组患者的疗效进行评价,客观评价指标包括拇指外展角度(掌侧、桡侧)、拇指力量(握力、捏力)、Kapandji评分,主观评价指标包括视觉模拟评分法(visual analogue scale,VAS)、臂肩手功能障碍(disabilities of the arm,shoulder and hand,DASH)评分,比较两组的疗效差异。结果术后所有患者均获得随访,时间为6~32个月,平均14.5个月,腕掌关节融合术与改良Eaton-Littler术术后末次随访的各评价指标:拇指外展角度(掌侧、桡侧)、拇指力量(握力、捏力)、VAS、DASH评分、Kapandji评分较术前均有改善(P<0.05),但两组之间差异无统计学意义(P>0.05)。结论腕掌关节融合术与改良Eaton-Littler术治疗EatonⅢ期第一腕掌关节炎都可以有效缓解疼痛、改善功能,两种手术方式的疗效均能使患者感到满意。

Objective To compare the clinical efficacy of carpometacarpal arthrodesis and modified Eaton-Littler′s reconstruction for the treatment of the first carpometacarpal joint osteoarthritis.Methods A retrospective analysis was conducted on 25 patients with EatonⅢstage of the first carpometacarpal joint osteoarthritis who underwent surgical treatment from May 2007 to November 2020.Among them,11 underwent carpometacarpal arthrodesis and 14 underwent modified Eaton-Littler′s reconstruction.The efficacy of the two groups of patients was evaluated,with objective evaluation indicators including thumb abduction angle(palmar and radial),thumb strength(grip and pinch),and Kapandji score.The subjective evaluation indicators include visual analogue scale(VAS)and disability of the arm,shoulder and hand(DASH)scores,and the efficacy differences between the two groups are compared.Results All patients were follow-up for a mean of 14.5 months,ranging from 6 to 32 months after surgery.The evaluation indicators for the last follow-up after carpometacarpal arthrodesis and modified Eaton-Littler′s reconstruction included thumb abduction angle(palmar and radial),thumb strength(grip and pinch),VAS,DASH score,and Kapandji score,were improved compared to before surgery,but there was no statistically significant difference between the two groups.Conclusion Both carpometacarpal arthrodesis and modified Eaton-Littler′s reconstruction can effectively alleviate pain and improve function in the treatment of EatonⅢstage of the first carpometacarpal joint osteoarthritis.The efficacy of both surgical methods can satisfy patients.