[拇指掌指关节尺侧副韧带损伤的外科治疗]
[Surgical treatment of ulnar collateral ligament injuries of the thumb metacarpophalangeal joint].
作者信息
Ziegler C, Neshkova I, Schmidt K, Meffert R, Jakubietz M, Jakubietz R
机构信息
Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universität Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland.
出版信息
Oper Orthop Traumatol. 2016 Apr;28(2):111-26; quiz 127. doi: 10.1007/s00064-015-0436-2. Epub 2016 Jan 14.
OBJECTIVE
Reconstruction of the ruptured ulnar collateral ligament of the metacarpophalangeal (MP) joint of the thumb.
INDICATIONS
Ruptured ulnar collateral ligament of the thumb MP joint with instability: joint opening of more than 30° in flexion and more than 20° in extension, Stener lesion, displaced avulsion fractures.
CONTRAINDICATIONS
Abrasions, wound-healing disturbance, skin disease, osteoarthritis.
SURGICAL TECHNIQUE
Curved skin incision dorsoulnar above the thumb MP joint. Protection of the branches of the superficial radial nerve. Incision of the adductor aponeurosis. Exposing the ulnar collateral ligament; opening and examination of the joint. Depending on the injury, primary suture repair, transosseous suture, repair with a bone anchor, osteosynthesis with K-wires or small screws in avulsion fracture, ligament reconstruction in chronic instability or older injury.
POSTOPERATIVE TREATMENT
Cast splint of the MP joint until swelling subsides; cast immobilization for 6 weeks; range-of-motion exercises, avoiding forced radial deviation of the MP joint for 3 months.
RESULTS
Complete joint stability 3 months postoperatively in all 34 patients with rupture of the ulnar collateral ligament.
目的
重建拇指掌指关节尺侧副韧带断裂。
适应症
拇指掌指关节尺侧副韧带断裂伴不稳定：屈曲时关节开口超过30°，伸展时超过20°，斯滕纳损伤，移位撕脱骨折。
禁忌症
擦伤、伤口愈合障碍、皮肤病、骨关节炎。
手术技术
在拇指掌指关节背尺侧做弧形皮肤切口。保护桡神经浅支分支。切开内收肌腱膜。暴露尺侧副韧带；打开并检查关节。根据损伤情况，进行一期缝合修复、经骨缝合、用骨锚修复、在撕脱骨折时用克氏针或小螺钉进行骨固定、在慢性不稳定或陈旧性损伤时进行韧带重建。
术后治疗
用石膏夹板固定掌指关节直至肿胀消退；石膏固定6周；进行活动度练习，3个月内避免掌指关节强行向桡侧偏斜。
结果
34例尺侧副韧带断裂患者术后3个月关节完全稳定。
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