Zouzias Ioannis C, Doft Melissa A, Uzumcugil Akin, Rosenwasser Melvin P
Department of Orthopedic Surgery, New York Orthopaedic Hospital, Columbia College of Physicians and Surgeons, New York, NY 10032, USA.
Tech Hand Up Extrem Surg. 2011 Jun;15(2):119-24. doi: 10.1097/BTH.0b013e3182019f92.
Advanced stages of basal joint arthritis are sometimes characterized by an adduction deformity of the first metacarpal and a hyperextension deformity of the unstable metacarpophalangeal (MCP) joint. Stabilizing the MCP joint in these patients is critical to ensure a pain-free repair and efficient pinch mechanism. This study presents the anatomic basis for a novel capsulodesis technique using the volar plate that can be incorporated into any reconstructive basal joint procedure when clinically indicated. Eleven normal cadavers were dissected to expose the volar plate. The dimensions of the volar plate, relationship of the sesamoid bones to the oblique pulley, and the distance from the sesamoids to the base of the proximal phalanx were compared between specimens. The radial border of the volar plate measured 8.5 ± 1.3 mm, ulnar border 8.8 ± 1.0 mm, proximal border 7.5 ± 1.0 mm, and distal border 7.8 ± 0.6 mm. The distance between the ulnar sesamoid bone and the oblique pulley measured 12.1 ± 1.1 mm and from the radial sesamoid to the oblique pulley measured 16.6 ± 0.2 mm. The distance between the sesamoids and the base of the phalanx measured 2.2 ± 0.2 mm. The anatomic studies provide a foundation on which the surgeon can understand the complex nature of the MCP joint. This study describes a novel technique for MCP capsulodesis of the thumb in which volar plate flaps are imbricated to provide stability to the MCP joint, obviating the need for suture anchors and tendon grafts.
基底关节关节炎的晚期有时表现为第一掌骨内收畸形和不稳定的掌指（MCP）关节过伸畸形。稳定这些患者的MCP关节对于确保无痛修复和有效的捏握机制至关重要。本研究提出了一种使用掌板的新型关节囊固定技术的解剖学基础，在临床指征明确时，该技术可纳入任何重建性基底关节手术中。解剖了11具正常尸体以暴露掌板。比较了各标本间掌板的尺寸、籽骨与斜滑车的关系以及籽骨到近节指骨基底的距离。掌板的桡侧缘测量值为8.5±1.3mm，尺侧缘为8.8±1.0mm，近端缘为7.5±1.0mm，远端缘为7.8±0.6mm。尺侧籽骨与斜滑车之间的距离测量值为12.1±1.1mm，桡侧籽骨到斜滑车的距离为16.6±0.2mm。籽骨与指骨基底之间的距离为2.2±0.2mm。这些解剖学研究为外科医生理解MCP关节的复杂性质提供了基础。本研究描述了一种拇指MCP关节囊固定的新技术，其中掌板皮瓣相互重叠以稳定MCP关节，无需缝合锚钉和肌腱移植。
