Fontes D
Service de Chirurgie Orthopédique et de Traumatologie, Hôpital Ambroise Paré, Boulogne, France.
Acta Orthop Belg. 1992;58(1):48-59.
The diagnosis of ligamentous injuries of the carpometacarpal joint of the thumb is too often missed or imprecise. Inadequate treatment may cause chronic instability and secondary rhizarthrosis. The important range of motion of the thumb arises from this joint, which is stabilized by ligaments that are liable to injury. The authors report the results of 10 ligament plasties, performed acutely on recent sprains, of which 8 were caused by sports injuries. Ball sports are usually responsible for radial instability from rupture of the strong ulnar ligament by sudden radial hyperabduction; this is treated by a plasty with the flexor carpi radialis, according to Eaton and Littler. Contact sports usually are the cause of ulnar instability by sudden retropulsion of the thumb; this is treated by a plasty with the abductor pollucis longus, according to Brunelli. These sports may also cause axial compression of the flexed thumb, resulting in radial instability from rupture of the capsuloligamentous structures; this lesion is treated by an augmentation plasty as proposed by Péquignot et al. (extensor carpi radialis brevis and abductor pollicis longus).
拇指腕掌关节韧带损伤的诊断常常被漏诊或诊断不准确。治疗不当可能导致慢性不稳定和继发性拇指关节病。拇指重要的活动范围源于该关节，其由易于受伤的韧带稳定。作者报告了10例韧带成形术的结果，这些手术是在近期扭伤后急性进行的，其中8例由运动损伤引起。球类运动通常是由于突然的桡侧过度外展导致强尺侧韧带断裂而引起桡侧不稳定；根据伊顿和利特勒的方法，这通过桡侧腕屈肌成形术进行治疗。接触性运动通常是由于拇指突然后推导致尺侧不稳定的原因；根据布鲁内利的方法，这通过拇长展肌成形术进行治疗。这些运动也可能导致屈曲拇指的轴向压缩，导致关节囊韧带结构断裂引起桡侧不稳定；这种损伤根据佩基尼奥等人的建议（桡侧腕短伸肌和拇长展肌）通过增强成形术进行治疗。
