大多角骨切除桡侧腕屈肌腱悬吊固定拇长展肌腱填塞治疗第1腕掌关节骨关节炎

摘要

Objective To introduce the surgical method and curative effectiveness of trapezium incision combined with flexor carpi radiali tendon suspension and thumb long exhibition tendons packing treating osteoarthritis of trapeziometacarpal joint. Methods From Dec 2010 to Nov 2013 eleven cases of osteoarthritis of trapeziometacarpal joint were treated by full excision of the trapezium, suspension fixation of the base of the first metacarpal by using half of the flexor carpi radialis (FCR) tendon and packing with half of the thumb long exhibition tendon through the skin incision from radial proximal of the first metacarpal to palm-radial side of carpal bone. The pain, the range of motion of joint and the grip strength were measured pre and postoperatively. Results Follow up was an average of 24 months, the 11 cases after operation included 4 excellent cases, 5 good cases, 2 medium and 0 poor cases. Clinical excellent and good rate was 81.82%, with a statistical significance of (27.27 ±10.09) Preoperatively to (87.27 ±6.84) posto-peratively. Conclusion The patients with osteoarthritis of trapeziometacarpal joint of period II and above, who has obvious symptoms but has no effection by conservative treatment of drug or rest etc, can be treated by full excision of the trapezium, suspension fixation of the base of the first metacarpal by using half of the flexor carpi radialis (FCR) tendon and packing with half of the thumb long exhibition tendon through the skin incision from radial proximal of the first metacarpal to palm-radial side of carpal bone. This operation can significantly inprove hand function and life quality of patients. It is a good treatment for osteoarthritis of trapeziometacarpal joint.%目的 介绍大多角骨切除加桡侧腕屈肌腱悬吊固定拇长展肌腱填塞治疗第1腕掌关节骨性关节炎的手术方法及疗效.方法 2010年12月—2013年11月,对11例患者采用第1掌骨近端桡侧至腕桡掌侧切口行大多角骨完全切除加1/2桡侧腕屈肌腱悬吊固定第1掌骨基底1/2拇长展肌腱填塞的方法治疗第1腕掌关节骨性关节炎. 根据改良MAYO评分标准,经过随访,对疼痛、关节活动度和握力及功能状态四项进行分级,以评价手术效果. 结果 经过平均24个月的随访,本组优4例,良5例,可2例,差0例,临床优良率为81.82%. 术前为(27.27±10.09)分,术后为(87.27±6.84)分,差异有统计学意义(P<0.01). 结论 第1腕掌关节骨关节炎Ⅱ期及Ⅱ期以上的患者,症状明显,药物、休息等保守治疗无效, 采用大多角骨完全切除加1/2桡侧腕屈肌腱悬吊固定第1掌骨基底部1/2拇长展肌腱填塞的方法治疗,可以很好地改善患手的功能,是目前治疗腕掌关节炎较好的方法.