CAJ | 학술논문

目的评价大多角骨切除,桡侧腕屈肌腱悬吊结合掌骨基底间韧带重建治疗第一腕掌关节骨关节炎的疗效.方法采用Schekker技术,应用大多角骨切除,桡侧半桡侧腕屈肌腱重建第一、二掌骨基底间韧带,并与剩余肌腱自身悬吊控制掌骨基底背侧半脱位,并形成肌腱填塞物内置大多角骨切除遗留空间控制掌骨下沉等手术步骤,治疗第一腕掌关节骨关节炎6例.术后手部功能评价指标包括握力(grip strength),捏力(key-pinch),第一腕掌关节直观模拟疼痛标尺法(visual analogue scales,VAS)及第一腕掌关节有效活动度评分(Kapandji score),术后12个月随访X线前后位片第一掌骨基底-舟骨远关节面间距,评价手术疗效.结果术后随访时间为12～ 26个月,平均15个月.手术前后疼痛(VAS)平均分值为7.0/1.6;握力平均为11/22 kg；捏力平均为1.8/3.4 kg;Kapandji score 平均为6.0/8.7；12个月时测量X线前后位片第一掌骨基底-舟骨远关节面间距平均值为8.8mm.结论大多角骨切除,桡侧腕屈肌腱动力性悬吊结合掌骨基底间韧带重建,最大程度地接近了该部位韧带解剖及生物力学方面的结构,可有效治疗第一腕掌关节骨关节炎.
목적 평개대다각골절제,뇨측완굴기건현조결합장골기저간인대중건치료제일완장관절골관절염적료효.방법 채용Schekker기술,응용대다각골절제,뇨측반뇨측완굴기건중건제일、이장골기저간인대,병여잉여기건자신현조공제장골기저배측반탈위,병형성기건전새물내치대다각골절제유류공간공제장골하침등수술보취,치료제일완장관절골관절염6례.술후수부공능평개지표포괄악력(grip strength),날력(key-pinch),제일완장관절직관모의동통표척법(visual analogue scales,VAS)급제일완장관절유효활동도평분(Kapandji score),술후12개월수방X선전후위편제일장골기저-주골원관절면간거,평개수술료효.결과 술후수방시간위12～ 26개월,평균15개월.수술전후동통(VAS)평균분치위7.0/1.6;악력평균위11/22 kg；날력평균위1.8/3.4 kg;Kapandji score 평균위6.0/8.7；12개월시측량X선전후위편제일장골기저-주골원관절면간거평균치위8.8mm.결론 대다각골절제,뇨측완굴기건동력성현조결합장골기저간인대중건,최대정도지접근료해부위인대해부급생물역학방면적결구,가유효치료제일완장관절골관절염.
Objective To investigate the treatment outcomes of suspension sling arthroplasty of the first trapeziometacarpal joint with flexor carpal radialis(FCR) tendon to stabilize the base of the first metacarpal after trapezium removal in patients who have suffered osteoarthritis of the first trapeziometacarpal joint. Methods Six cases of the first trapeziometacarpal joint osteoarthritis were treated using Scheker's techniques.After removing the trapezium the intermetacarpal ligament between the first and second metacarpal bases was reconstructed with half of the FCR tendon which was sewed back to its intact half to form a pinecone in order to prevent the dorsal subluxation and proximal migration of the thumb metacarpal.Postoperative evaluations included grip strength,key-pinch strength,visual analogue scales (VAS) and Kapandji Score.X-rays were taken 12 months after the surgery to measurme the distance between the first metacarpal base and distal scaphoid articular surface. Results Follow-up was an average of 15 months,ranging from 12 to 26 months.Postoperative VAS of pain decreased from 7.0 to 1.6.Grip strength increased from 11 to 22 kg,while key pinch increased from 1.8 to 3.4 kg.Kapandji Score increased from 6.0 to 8.7.The average space between the first metacarpal base and distal scaphoid articular surface was 8.8 mm on A-P view X-ray. Conclusion Dynamic suspension sling arthroplasty of the first trapeziometacarpal joint stabilizes the base of the first metacarpal after trapezium removal.It achieves the greatest degree of being close to the anatomical and biomechanical structure of the ligament and plays an effective role for treating this kind of disease.