大多角骨切除对腕关节稳定性影响的研究

摘要

目的 观察大多角骨切除术后腕关节影像学及临床检查结果的变化,明确该术式对腕关节稳定性的影响.方法 2008年1月至2011年1月,应用大多角骨切除术治疗第一腕掌关节骨性关节炎患者19例(21拇指).分别记录术前和术后的影像学和临床检查结果.影像学检查指标包括:桡舟角、桡月角、舟月角、月头角及腕高比;临床检查指标包括:握力、指尖捏力及视觉模拟评分法(visual analogue scale,VAS)评分.对术前存在背侧插入段不稳定(dorsal intercalated segmentinstability,DISI)的病例亦进行影像学分析,并对上述结果进行统计学分析.结果 术后全部患者获得随访,时间为6～37个月,平均14.7个月.影像学检查结果显示,术后舟月角较术前减小,但桡舟角、桡月角、月头角及腕高比术前与术后结果差异均无统计学意义.临床检查结果显示,术后握力和指尖捏力较术前增加,但差异均无统计学意义.术后VAS评分较术前下降,差异有统计学意义.术前出现DISI的比例为28.6％(6/21),术后DISI的比例为33.3％ (7/21).术前存在DISI病例的影像学结果显示,术后月头角较术前减小,但桡舟角、桡月角、舟月角及腕高比术前与术后结果差异均无统计学意义.结论 影像学和临床观察指标显示,大多角骨切除术对腕关节稳定性均无显著影响.术前存在DISI的病例在大多角骨切除术后,腕关节不稳定也并无加剧表现.%Objective To examine the radiographic and clinical changes of trapezietomy,and determine the effect of this procedure on carpal instability.Methods From January 2008 to January 2011,19 patients (21 thumbs) with thumb carpometacarpal arthritis were treated with trapeziectomy and ligament reconstruction tendon interposition arthroplasty with flexor carpi radialis (FCR).Pre-and post-operative radiographic and clinical parameters were compared.Radiographic measurements included radioscaphoid angle,radiolunate angle,scapholunate angle,lunate capitate angle and carpal height ratio.Clinical evaluations included grip strength,pinch strength,and pain level quantified by visual analogue scale (VAS).The existence of dorsal intercalated segment instability (DISI) deformity was also evaluated radiographically.Results All the patients were followup for 6 to 37 months,with an average of 14.7 months.The mean radioscaphoid angle was 44°preoperatively and 40°postoperatively; radiolunate angle was 8°preoperatively and 10° postoperatively; scapholuante angle was 51° preoperatively and 48° postoperatively; lunocapitate angle was 14° preoperatively and 12° postoperatively.There were no significant changes except the scapholunate angle which was significantly reduced after the surgery.Grip strength improved from 18.6 to 20.5 kg,and pinch strength increased from 4.4 to 4.5 kg after the surgery.Patient pain levels (VAS) were significantly reduced from 6.6 to 0.5.DISI deformity was present in 28.6 ％ (6/ 21) of the patients preoperatively and 33.3 ％ (7/21) after the surgery.In the DISI cases,the procedure did not change the radioscaphoid angle,radiolunate angle,scapholunate angle and carpal height ratio.The lunate capitate angle however was significantly reduced.Conclusion Both radiographic and clinical parameters showed that trapeziectomy does not significantly affect carpal stability.DISI deformity is not worsened by trapeziectomy either.