摘要
[目的]比较第5腕掌关节部分移植与关节成形治疗掌指关节缺损的临床疗效。[方法]回顾性分析2016年3月—2022年12月本院收治的32例外伤导致掌指关节缺损患者的临床资料,根据术前沟通结果,16例采用第5腕掌关节部分移植治疗,16例采用关节成形治疗,比较两组围手术期、随访和影像结果。[结果]所有患者均顺利完成手术,术中均无神经血管等严重并发症。移植组的手术时间[(137.0±16.4)min vs(102.5±12.5)min,P<0.005]和术中透视次数[(28.1±1.4)次vs(23.1±0.8)次,P=0.006]显著大于成形组,但两组间术中出血量、切口总长度、平均住院时间、住院费用、石膏外固定时间的差异均无统计学意义(P>0.05)。32例患者随访时间平均(17.7±4.0)个月,随时间推移,两组术后VAS评分和DASH评分均显著减少(P<0.05),而握力、掌指关节ROM、Carroll手功能试验评分显著增加(P<0.05)。术后1、3个月DASH评分[(83.2±3.9)vs(89.9±5.4),P=0.003;(55.3±6.2)vs(61.4±6.9),P=0.022]、术后3个月和末次随访时掌指关节ROM[(62.5±5.4)°vs(56.6±7.3)°,P=0.033;(82.2±4.3)°vs(76.9±5.2)°,P=0.004]、Carroll手功能试验评分[(77.8±4.0)vs(74.9±3.2),P=0.022;(92.6±3.6)vs(88.5±3.2),P=0.004]、术后1个月和末次随访握力[(26.8±3.7)kg vs(22.9±3.5)kg,P=0.009;(48.9±5.8)kg vs(44.1±5.0)kg,P=0.009]移植组均明显优于成形组。术后影像方面,两组骨折愈合时间的差异无统计学意义(P>0.05),末次随访时移植组的相对关节间隙显著大于成形组[(1.03±0.68)%vs(0.86±0.11)%,P=0.002]。[结论]第5腕掌关节部分移植治疗掌指关节部分缺损,尤其是伴有肌腱、韧带止点缺损的患者,可更好重建关节完整性和稳定性,更利于掌指关节功能恢复。
[Objective]To compare the clinical consequence of partial transplantation of the fifth carpometacarpal joint versus arthro⁃plasty in the treatment of metacarpophalangeal defects.[Methods]A retrospective study was conducted on 32 patients who underwent surgi⁃cal treatment for metacarpophalangeal defect due to trauma in our hospital from March 2016 to December 2022.According to preoperativesurgeon-patients discussion,16 patients were treated with partial transplantation of the fifth carpometacarpal joint,while other 16 patientswere with then conventional arthroplasty.The documents regarding perioperative period,follow-up and imaging were compared betweenthe two groups.[Results]All patients in both groups had corresponding surgical procedures performed successfully without serious compli⁃cations such as neurovascular injuries.The transplantation group consumed significantly longer operative time[(137.0±16.4)min vs(102.5±12.5)min,P<0.005]and more intraoperative fluoroscopy times[(28.1±1.4)vs(23.1±0.8),P=0.006]than the arthroplasty group.However,there were no significant differences in intraoperative blood loss,total incision length,hospital stay,hospitalization cost and postoperativeplaster fixation time between the two groups(P>0.05).With time elapsed during the follow-up period lasted for(17.7±4.0)months in amean,the VAS and DASH scores in both groups were significantly decreased(P<0.05),while grip strength,metacarpophalangeal ROM andCarroll hand function test scores were significantly increased(P<0.05).The transplantation group proved significantly superior to the arthro⁃plasty group in terms DASH score[(83.2±3.9)vs(89.9±5.4),P=0.003;(55.3±6.2)vs(61.4±6.9),P=0.022]1 and 3 months postoperatively,metacarpophalangeal ROM[(62.5±5.4)°vs(56.6±7.3)°,P=0.033;(82.2±4.3)°vs(76.9±5.2)°,P=0.004]and Carroll score[(77.8±4.0)vs(74.9±3.2),P=0.022;(92.6±3.6)vs(88.5±3.2),P=0.004]3 months after operation and at the latest follow-up,as well as grip strength[(26.8±3.7)kg vs(22.9±3.5)kg,P=0.009;(48.9±5.8)kg vs(44.1±5.0)kg,P=0.009]1 month after surgery and at the last follow-up.As for postoper⁃ative imaging,there was no significant difference in fracture healing time between the two groups(P>0.05),whereas the transplantationgroup had significantly greater relative joint space than the arthroplasty group at the last follow-up[(1.03±0.68)%vs(0.86±0.11)%,P=0.002].[Conclusion]Partial transplantation of the fifth carpometacarpal joint for metacarpophalangeal partial defect,especially with ten⁃don and ligament insertion defect,does better rebuild the integrity and stability of the joint,and is more conducive to the functional recov⁃ery of the metacarpophalangeal joint.
作者
王崧伊
谭新欢
刘书燕
鞠昌军
翟建国
周鑫
金海龙
蔄志英
WANG Song-yi;TANXin-huan;LIU Shu-yan;JU Chang-jun;ZHAI Jian-guo;ZHOU Xin;JIN Hai-long;MAN Zhi-ying(Wendeng Orthopaedic Hospital of Shandong Province,Weihai 264400,Shandong,China)
出处
《中国矫形外科杂志》
北大核心
2025年第16期1441-1448,共8页
Orthopedic Journal of China
基金
威海市中医药科技项目面上项目(编号:2023N-07)。
关键词
关节移植
关节成形
掌指关节
腕掌关节
关节缺损
joint transplantation
arthroplasty
metacarpophalangeal joint
carpometacarpal joint
articular defect
