摘要
目的介绍小关节镜微创治疗第1腕掌关节疾病的常用手术方法及临床初步应用结果。方法回顾分析2013年1月至2015年12月北京积水潭医院手外科采用1.9 mm小关节镜及配套小关节镜手术器械行第1腕掌关节手术的11例患者的临床资料。对其中2例关节内游离体行游离体取出术,2例关节滑膜炎行滑膜切除术,5例骨关节炎行大多角骨部分切除关节成形术,2例韧带松弛行韧带皱缩术。术后随访以疼痛视觉模拟评分(VAS)、臂肩手功能障碍评分(DASH)、Kapandji评分以及拇指与示指侧方的侧捏力量等指标对效果进行评价。结果通过小关节镜成功对所有患者第1腕掌关节的结构进行了观察,对病变进行了评估。2例接受关节内游离体取出的患者术后关节活动时的卡顿疼痛感消失。2例接受滑膜切除患者平均VAS评分从5.0分降至1.0分,平均Kapandji评分从9.0分增至10.0分。2例接受韧带皱缩患者术后平均DASH评分从23.9分降至0分。5例接受大多角骨部分切除关节成形术患者,术后平均VAS评分从6.8分降至0.4分,平均DASH评分从61.7分降至3.2分,平均Kapandji评分从6.8分提高至9.4分。患侧捏力占健侧捏力百分比从术前平均82.6%(60.0%~107.0%)增至术后96.0%(68.8%~111.0%)。结论小关节镜对适宜的第1腕掌关节疾病进行治疗的近期随访结果满意,是一种安全有效的微创治疗选择。
Objective To introduce surgical techniques and preliminary outcomes of the first carpometacarpal joint arthroscopy. Methods Eleven carpometacarpal joint arthroscopic procedures were performed using a 1. 9 mm arthroscope with standard supportive equipment between January 2013 and December 2015. The arthroscopic procedures include 2 free body removal procedures for patients with intraarticular free bodies,2 synovectomy procedures for patients with synovitis,5 arthroscopic partial trapeziectomy hematoma arthroplasty procedures for patients with thumb carpometacarpal arthritis,and 2 ligament thermal shrinkage procedures for patients with ligament laxity. All patients were clinically assessed at post-operative follow-up for potential complications and outcomes. Visual Analogue Scale（ VAS） was used to assess pre-operative and post-operative pain. The Disabilities of the Arm,Shoulder and Hand Score（ DASH） was used to assess upper limb function.The range of motion of the first carpometacarpal joint was assessed by Kapandji score. Results Successful exploration of the first carpometacarpal joint was achieved by means of small joint arthroscopy for each patient.The therapeutic procedures were performed arthroscopically according to the pathology of each patient. All patients had symptom relief and were satisfied with the outcomes. No complication was observed. Two patients underwent free body removal reported the disappeared sense of locking. Two patients underwent arthroscopic synovectomy reported pain relief（ mean VAS decreased from 5. 0 to 1. 0） and increased range of motion（ mean Kapandji score increased from 9. 0 to 10. 0）. Five patients underwent arthroscopic partial trapeziectomy hematoma arthroplasty had pain relief（ mean VAS decreased from 5. 0 to 1. 0）,improved mean DASH score（ from 61. 1 to 3. 2） and increased range of motion（ mean Kapandji score increased from 6. 8 to 9. 4）. Conclusion Small joint arthroscopy is a reliable and effective surgical procedure for the management of select
出处
《骨科临床与研究杂志》
2017年第5期279-283,共5页
Journal Of Clinical Orthopedics And Research
基金
北京市"十百千"卫生人才"千"层次项目(2011)
北京积水潭医院FRCS人才培训基金(2013)~~
关键词
腕掌关节
关节镜检查
外科手术
微创性
Carpometacarpal joint
Arthroscopy
Surgical procedures
minimally invasive
