大多角骨切除联合韧带重建异体肌腱填塞治疗第1腕掌骨关节炎的疗效评价

Evaluation of the efficacy of trapezium bone resection combined with ligament reconstruction and allogeneic tendon tamponade in the treatment of the first carpometacarpal osteoarthritis

目的通过对大多角骨切除联合韧带重建异体肌腱填塞治疗第1腕掌关节炎的随访和研究,用以评价该术式的治疗效果。方法2017年1月-2022年6月,本科采用大多角骨切除联合韧带重建异体肌腱填塞治疗第1腕掌骨关节炎(EatonⅢ期及Ⅳ期)患者25例,术前根据影像学Eaton分期:Ⅲ期4例,Ⅳ期21例。术后评价治疗效果,客观评价包括患肢捏力、握力、拇指外展角度(掌侧、桡侧)、拇指对掌功能评分(Kapandj评分)和第1掌沉降率;主观评价包括视觉模拟评分(VAS)及上肢功能障碍评分(DASH)。结果术后25例平均随访16个月,末次随访时,所有患者疼痛明显减轻,力量明显提高,关节活动范围及功能明显改善,第1掌骨的高度得到了较好的维持,第1腕掌关节的功能恢复良好,并且能回到之前的工作岗位,按照Robbins腕关节评分标准综合评定:优12例,良11例,可2例,优良率达92.0%。结论大多角骨切除联合韧带重建异体肌腱填塞治疗第1腕掌骨关节炎可明显缓解疼痛,改善第1腕掌关节功能,并能在术后维持第1掌骨的高度,疗效确实值得推广应用。

Objective To evaluate the effect of the operation by the follow-up study of the treatment of the first carpo metacarpal joint with the resection of the trapezium bone and the reconstruction of the ligament.Methods From January 2017 to June 2022,we treated 25 patients with the first carpometacarpal osteoarthritis(Eaton stage III and IV)with tapezium resection combined with ligament reconstruction and allogeneic tendon tamponade.According to the imaging Eaton stage before operation,4 cases were in stage III and 21 cases were in stage IV.The therapeutic effect was evaluated after operation.The objective evaluation included pinch strength,grip strength,thumb abduction angle(volar,radial),thumb opposition function score(Kapandj score)and the first palm sedimentation rate.Subjective evaluation included visual analogue scale(VAS)and upper limb dysfunction score(DASH).Results Twenty-five patients were followed up for an average of 16 months.At the last follow-up,the postoperative pain was significantly reduced and the strength was significantly improved.The range of motion and function of the joint were significantly improved.The height of the first metacarpal bone was well maintained after operation.The function of the first carpometacarpal joint recovered well and was able to return to previous work.According to the Robbins wrist score,the excellent and good rate of the operation was 83.6%.Conclusion The treatment of trapezium bone resection combined with ligament reconstruction and allogeneic tendon packing in the treatment of the first carpometacarpal osteoarthritis can significantly relieve pain,improve the function of the first carpometacarpal joint,and maintain the height of the first metacarpal bone after operation.The curative effect is indeed worthy of popularization and application.