Ito Jun, Koshino Tomihisa, Okamoto Renzo, Saito Tomoyuki
Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
J Hand Surg Am. 2003 Jul;28(4):585-90. doi: 10.1016/s0363-5023(03)00202-8.
In this study we radiologically evaluated the effects of extensor carpi radialis longus (ECRL) tendon transfer on the stability and deformity of joints of rheumatoid hands in cases with a postoperative period of more than 5 years.
Synovectomy concomitant with tendon transfer of the ECRL to the extensor carpi ulnaris (Clayton's procedure) was performed in 28 wrists of 23 patients with rheumatoid arthritis. The follow-up period was 8.8 +/- 2.8 years. Pre- and postoperative x-rays were reviewed and measured. Follow-up evaluation included Steinbrocker's classification of the radiocarpal joints, Larsen's grade of the third metacarpophalangeal (MCP) joint, radial angulation of the wrist, ulnar translocation of the carpus, and ulnar drift of the fingers.
Nineteen of 28 wrists (68%) were ankylosed (radius-proximal carpal row fusion or radiolunate limited fusion). Radial angulation of the wrist was reduced from 131 degrees +/- 8.8 degrees before surgery to 121 degrees +/- 7.9 degrees after surgery. Dislocation and ulnar translocation of the carpus (UTC) were prevented by surgery (UTC: 1.05 +/- 0.10 before and 1.07 +/- 0.09 after surgery). The mean ulnar drift of the fingers was maintained at the preoperative level (UDF: 14 degrees +/- 5.7 degrees before and 14 degrees +/- 12.9 degrees after surgery). The incidence of alteration (increase and decrease) of UDF of more than 5 degrees between pre- and postoperative evaluation was significantly higher in the group with worsening of Larsen grade of MCP joints than in the group without worsening (with worsening: 7 of 8 MCP joints, without worsening: 8 of 20 MCP joints).
ECRL tendon transfer (Clayton's procedure) provided effective stabilization at more than 5 years (mean, 8.8 y) after surgery. In addition, this method may help to prevent ulnar drift of the fingers if combined with correction of local factors at the MCP joints.
在本研究中，我们对23例类风湿性关节炎患者的28个腕关节进行了放射学评估，这些患者接受桡侧腕长伸肌（ECRL）肌腱转位手术超过5年，以评估该手术对类风湿性手部关节稳定性和畸形的影响。
对23例类风湿性关节炎患者的28个腕关节进行了滑膜切除术，并将ECRL肌腱转位至尺侧腕伸肌（克莱顿手术）。随访期为8.8±2.8年。回顾并测量术前和术后的X线片。随访评估包括桡腕关节的斯坦布鲁克分类、第三掌指（MCP）关节的拉森分级、腕关节的桡偏角、腕骨的尺侧移位以及手指的尺侧偏斜。
28个腕关节中有19个（68%）发生了关节融合（桡骨近端腕骨排融合或桡月关节有限融合）。腕关节的桡偏角从术前的131°±8.8°降至术后的121°±7.9°。手术预防了腕骨的脱位和尺侧移位（腕骨尺侧移位：术前1.05±0.10，术后1.07±0.09）。手指的平均尺侧偏斜维持在术前水平（手指尺侧偏斜：术前14°±5.7°，术后14°±12.9°）。MCP关节拉森分级恶化组术前和术后评估之间手指尺侧偏斜改变（增加和减少）超过5°的发生率显著高于未恶化组（恶化组：8个MCP关节中的7个，未恶化组：20个MCP关节中的8个）。
ECRL肌腱转位（克莱顿手术）在术后5年以上（平均8.8年）提供了有效的稳定作用。此外，如果结合MCP关节局部因素的矫正，该方法可能有助于预防手指的尺侧偏斜。
