CAJ | 학술논문

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.
목적 관찰대다각골절제술후완관절영상학급림상검사결과적변화,명학해술식대완관절은정성적영향.방법 2008년1월지2011년1월,응용대다각골절제술치료제일완장관절골성관절염환자19례(21무지).분별기록술전화술후적영상학화림상검사결과.영상학검사지표포괄:뇨주각、뇨월각、주월각、월두각급완고비;림상검사지표포괄:악력、지첨날력급시각모의평분법(visual analogue scale,VAS)평분.대술전존재배측삽입단불은정(dorsal intercalated segmentinstability,DISI)적병례역진행영상학분석,병대상술결과진행통계학분석.결과 술후전부환자획득수방,시간위6～37개월,평균14.7개월.영상학검사결과현시,술후주월각교술전감소,단뇨주각、뇨월각、월두각급완고비술전여술후결과차이균무통계학의의.림상검사결과현시,술후악력화지첨날력교술전증가,단차이균무통계학의의.술후VAS평분교술전하강,차이유통계학의의.술전출현DISI적비례위28.6％(6/21),술후DISI적비례위33.3％ (7/21).술전존재DISI병례적영상학결과현시,술후월두각교술전감소,단뇨주각、뇨월각、주월각급완고비술전여술후결과차이균무통계학의의.결론 영상학화림상관찰지표현시,대다각골절제술대완관절은정성균무현저영향.술전존재DISI적병례재대다각골절제술후,완관절불은정야병무가극표현.
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.