Başar H, Başar B, Kaplan T, Erol B, Tetik C
Department of orthopedics and traumatology, Sakarya training and research hospital, Sakarya, Turkey.
Department of physical medicine and rehabilitation, Akyazı state hospital, Sakarya, Turkey.
Chir Main. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Epub 2014 Oct 22.
This study sought to demonstrate that successful outcomes can be achieved with the new technique presented here for chronic ulnar collateral ligament (UCL) injury of the thumb metacarpophalangeal (MCP) joint, as well as with K-wire pinning for acute UCL injury. We followed 19 patients who suffered an UCL rupture (mean follow-up: 14.26±4.65 months) and 32 patients who presented with UCL avulsion fracture (mean follow-up: 16.81±7.54 months). We used a free tendon graft for UCL reconstruction in the UCL rupture group. Both ends of the graft were stabilized with bioabsorbable suture anchors, which were used as biotenodesis interference screws. Closed reduction and K-wire fixation was used in UCL avulsion fracture group. There were no statistically significant differences between operated and contralateral healthy thumb MCP joint in both groups in the grip strength, tip pinch strength, flexion, extension, ulnar deviation, and radial deviation movements at final follow-up. Grip strength, tip pinch strength, ulnar deviation and radial deviation were significantly better in the avulsion group than the rupture group. All patients regained full stability at the MCP joint in avulsion group; 16 patients regained full stability and 3 patients presented with mild laxity (less than 10° laxity) in rupture group. Glickel grading scale used as a functional score was excellent for 30 patients and good for 2 patients in avulsion group; it was excellent for 17 patients and good for 2 patients in rupture group. Our study shows that closed reduction and percutaneous K-wire fixation of acute displaced large UCL avulsion fracture is a simple technique and achieves adequate stability of UCL. For UCL rupture, free tendon reconstruction with bioabsorbable suture anchors provides adequate stability and stable fixation within the tunnels.
本研究旨在证明，对于拇指掌指（MCP）关节慢性尺侧副韧带（UCL）损伤，采用本文介绍的新技术以及针对急性UCL损伤采用克氏针固定，均可取得成功的治疗效果。我们对19例发生UCL断裂的患者（平均随访时间：14.26±4.65个月）和32例出现UCL撕脱骨折的患者（平均随访时间：16.81±7.54个月）进行了随访。在UCL断裂组中，我们使用游离肌腱移植进行UCL重建。移植肌腱的两端用可吸收缝合锚钉固定，这些锚钉用作生物固定干涉螺钉。UCL撕脱骨折组采用闭合复位和克氏针固定。在末次随访时，两组手术侧与对侧健康拇指MCP关节在握力、指尖捏力、屈曲、伸展、尺侧偏斜和桡侧偏斜运动方面均无统计学显著差异。撕脱组的握力、指尖捏力、尺侧偏斜和桡侧偏斜均显著优于断裂组。撕脱组所有患者MCP关节均恢复了完全稳定性；断裂组16例患者恢复了完全稳定性，3例患者出现轻度松弛（松弛度小于10°）。作为功能评分的Glickel分级量表，撕脱组30例患者为优，2例患者为良；断裂组17例患者为优，2例患者为良。我们的研究表明，急性移位的大型UCL撕脱骨折的闭合复位和经皮克氏针固定是一种简单的技术，可实现UCL的充分稳定。对于UCL断裂，使用可吸收缝合锚钉进行游离肌腱重建可提供足够的稳定性，并在隧道内实现稳定固定。
