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
赵喆 1耿红荔 2刘建全 2李永胜 2尹建文 2陈小强 2王光辉 2程翔宇 2李嘉贝 2邓志钦 2董傲铮铮 2王满宜 2郑小飞 3李文翠2
作者信息
- 1. 深圳市第二人民医院(深圳大学第一附属医院)足踝外科手外科,深圳 518035;暨南大学附属第一医院运动医学科,广州 510630
- 2. 深圳市第二人民医院(深圳大学第一附属医院)足踝外科手外科,深圳 518035
- 3. 暨南大学附属第一医院运动医学科,广州 510630
- 折叠
摘要
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Eaton Ⅱ、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Eaton Ⅱ、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Ka-pandji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.
Abstract
Objective To analyze the clinic effects of arthroscopic partial trapeziectomy and suture button suspension-plasty in the treatment of first carpometacarpal joint(CMCJ)Eaton stage Ⅱ/Ⅲ arthrosis.Methods A retrospective study was con-ducted 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 postopera-tive 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 Ka-pandji'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 signifi-cant 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 su-ture 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.
关键词
腕掌关节/关节镜检查/大多角骨/襻钢板/悬吊Key words
Carpometacarpal joints/Arthroscopy/Trapezoid/Suture button/Suspension引用本文复制引用
基金项目
教育部中国高校产学研创新基金(2021JH037)
广东省骨科重点临床学科建设项目(2000005)
深圳市重点医学学科建设项目(SZXK025)
深圳市医疗卫生三名工程项目(SZSM202311008)
深圳市第二人民医院高水平医院院级临床研究项目(GK202203003)
出版年
2024
NETL
NSTL
维普
万方数据