Rein S, Mittag-Bonsch M
Klinik und Poliklinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum "Carl Gustav Carus" Dresden.
Z Orthop Unfall. 2011 Oct;149(5):560-7. doi: 10.1055/s-0030-1271137. Epub 2011 May 18.
This study analyses the outcome of a transosseous suture fixation for the ulnar collateral ligament (UCL) of the thumb, which is performed completely internally.
60 patients with distal rupture of the UCL of the thumb were surgically treated with a transosseous suture technique. Patients with ligament tears surgically treated within 14 days after injury were included in Group 1 (n = 33); patients with delayed surgical treatment (> 14 days after injury) in Group 2 (n = 13). Group 3 (n = 14) contained patients with avulsion fractures. Subjective, functional, and radiological outcomes were evaluated after at least 24 months, and up to an average of 68 months after surgery. Statistical analysis was performed using the Kruskal-Wallis test, Mann-Whitney test, chi-square test, and Wilcoxon test.
No significant differences were seen for the disability of the arm, shoulder and hand (DASH) scores among the groups. The average DASH score was 2.4 ± 3 points in Group 1, 4.6 ± 9 points in Group 2 and 5 ± 8 points in Group 3. The visual and verbal pain analogue scales showed significant differences between Groups 1 and 2 at (p = 0.02) and after exertion (p = 0.03). Significant differences were seen for the flexion of the interphalangeal joint in Group 1 (p = 0.004) and the radial abduction of the thumb in Group 3 (p = 0.001), as compared to the contralateral hand. Furthermore, significant differences were obtained for the pinch strength between the thumb and the ring finger in Group 1 (p = 0.03) and 3 (p = 0.04), as well as pinch (p = 0.02) and key strength (p = 0.03) of the little finger in Group 1, again compared to the contralateral hand. Group 3 (p < 0.001) showed significantly more radiological bony alterations at the distal UCL insertion than the other groups.
This study shows good to very good subjective, functional, and radiological results in all three groups. Therefore, we recommend this transosseous suture fixation as an affordable, practicable technique for the treatment of acute rupture of the UCL of the thumb with and without avulsion fractures.
本研究分析了完全在关节内进行的拇指尺侧副韧带经骨缝合固定术的疗效。
60例拇指尺侧副韧带远端断裂患者接受了经骨缝合技术的手术治疗。受伤后14天内接受手术治疗的韧带撕裂患者纳入第1组（n = 33）；受伤后超过14天接受延迟手术治疗的患者纳入第2组（n = 13）。第3组（n = 14）包括伴有撕脱骨折的患者。在术后至少24个月、平均长达68个月后评估主观、功能和放射学结果。采用Kruskal-Wallis检验、Mann-Whitney检验、卡方检验和Wilcoxon检验进行统计学分析。
各组间上肢、肩部和手部功能障碍（DASH）评分无显著差异。第1组的平均DASH评分为2.4±3分，第2组为4.6±9分，第3组为5±8分。视觉和言语疼痛模拟量表显示，第1组和第2组在静息时（p = 0.02）和用力后（p = 0.03）存在显著差异。与对侧手相比，第1组指间关节屈曲（p = 0.004）和第3组拇指桡侧外展（p = 0.001）存在显著差异。此外，与对侧手相比，第1组和第3组拇指与环指之间的捏力（第1组p = 0.03，第3组p = 0.04）以及第1组小指的捏力（p = 0.02）和钥匙握力（p = 0.03）存在显著差异。第3组（p < 0.001）在尺侧副韧带远端附着处的放射学骨质改变明显多于其他组。
本研究显示所有三组的主观、功能和放射学结果均为良好至非常好。因此，我们推荐这种经骨缝合固定术作为一种经济实惠、切实可行的技术，用于治疗伴有或不伴有撕脱骨折的拇指尺侧副韧带急性断裂。
