You Ji Peng, Lu Lu, Li Cong Jie, Ren Bao, Wang Tao
Department of Orthopaedics Department of Emergency Department of Anesthesiology Department integrated Chinese and Western medicines. Affiliated Hospital of Hebei University, Baoding, China.
Medicine (Baltimore). 2018 Feb;97(5):e9665. doi: 10.1097/MD.0000000000009665.
Thumb carpometacarpal (CMC) arthritis is a common disease. Various procedures have been described for the treatment of advanced thumb CMC arthritis. This essay shows a CMC arthritis case treated by modified trapeziectomy with ligament reconstruction tendon interposition (LRTI).
A 53-year-old Chinese female complained of pain and swelling at the base of the left thumb for 10 years. Visual analog scale (VAS) for thumb was 7 points, Disabilities of Arm, Shoulder and Hand (DASH) score was 51 points, and Kapandji score was 6 points before surgery. Preoperative range of motion (ROM) for radial abduction and volar abduction were 63°and 62°, respectively. Grip power was 15.3 kg and key-pinch power was 1.8 kg before operation. Preoperative waist flexion power was 20.9 kg. Hand x-ray showed left thumb CMC arthritis in Eaton stage III and the height of the trapezial space was 10 mm.
She was diagnosed with left thumb CMC arthritis (Eaton III stage).
The patient underwent modified trapeziectomy with LRTI. After exposing and removing trapezium, and a hole from the dorsal base to the center of the articular surface was drilled. Then we cut the whole flexor carpi radialis and divided it into 2 halves. Afterward, we passed one-half through the hole and tied it to the other part and sutured them. The rest tendon was then tied continuously and sutured. Then we rolled it up into the space where previous trapezium was located.
Two years after operation, pain and swelling relieved and no recurrence of the clinical symptoms occurred. VAS, DASH, and Kapandji score were 2, 22, 7 points, respectively. ROM for radial abduction and volar abduction were 79° and 78°, respectively. Furthermore, grip power was 22.7 kg and key-pinch power was 3.8 kg. Waist flexion power was 20.0 kg. Hand x-ray showed that the height of the trapezial space was 9.8 mm.
Modified trapeziectomy with LRTI in treatment of advanced thumb CMC arthritis had a satisfactory efficacy. This new procedure not only prevents thumb sinking, but also provides enough support for thumb.
拇指腕掌关节（CMC）关节炎是一种常见疾病。已经描述了多种治疗晚期拇指CMC关节炎的手术方法。本文展示了一例采用改良大多角骨切除术加韧带重建肌腱植入术（LRTI）治疗的CMC关节炎病例。
一名53岁的中国女性，主诉左手拇指基部疼痛肿胀10年。术前拇指视觉模拟评分（VAS）为7分，上肢、肩部和手部功能障碍（DASH）评分为51分，卡潘迪评分（Kapandji score）为6分。术前桡侧外展和掌侧外展的活动范围（ROM）分别为63°和62°。术前握力为15.3千克，捏力为1.8千克。术前腰部屈曲力量为20.9千克。手部X线显示左手拇指CMC关节炎处于伊顿（Eaton）III期，大多角骨间隙高度为10毫米。
诊断为左手拇指CMC关节炎（伊顿III期）。
患者接受了改良大多角骨切除术加LRTI。暴露并切除大多角骨后，从背侧基部向关节面中心钻一个孔。然后切断整个桡侧腕屈肌并将其分成两半。之后，将其中一半穿过孔并与另一部分系在一起并缝合。然后将其余的肌腱连续系紧并缝合。然后将其卷成先前大多角骨所在的间隙。
术后两年，疼痛和肿胀缓解，临床症状未复发。VAS、DASH和卡潘迪评分分别为2分、22分、7分。桡侧外展和掌侧外展的ROM分别为79°和78°。此外，握力为22.7千克，捏力为3.8千克。腰部屈曲力量为20.0千克。手部X线显示大多角骨间隙高度为9.8毫米。
改良大多角骨切除术加LRTI治疗晚期拇指CMC关节炎疗效满意。这种新手术不仅可防止拇指下沉，还能为拇指提供足够的支撑。
