拇指桡侧副韧带修复：术后缺损的长期结果和预测因素。
Radial collateral ligament repair of the thumb: long-term outcomes and predictive factors of postoperative deficits.
机构信息
Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
Arch Orthop Trauma Surg. 2020 Sep;140(9):1293-1299. doi: 10.1007/s00402-020-03509-0. Epub 2020 Jun 4.
BACKGROUND
The thumb's radial collateral ligament (RCL) plays an important role in stabilizing the first metacarpophalangeal joint (MCP-1). RCL injuries are rare and treatment recommendations are inconsistent in the current literature. The aim of this study was to report on long-term outcomes following surgical repair of thumb RCL tear and to identify prognostic risk factors for treatment failure.
METHODS
Patients with RCL tear from 10/1998 to 10/2019 were included in the present retrospective single center cohort study. In follow-up visits, participants were assessed regarding pain, range of motion and strength as well as with disability of shoulder, arm and hands (DASH), and the Short-Form 36 (SF36) questionnaires. Finally, predictive factors of postoperative deficits were identified.
RESULTS
43 patients fulfilled inclusion criteria. Median age was 43.5 years (range 18-80 years). The most frequent mechanism of injury was a fall or impact. Bony avulsions were identified in 46.5% (20/43). Time from injury to surgery was 12 days (0-276 days). One Stener-like lesion was observed intraoperatively among our patients. After surgical repair, the MCP-1 joint was stable in every patient. Mean time to follow-up was 5.3 years (1 month to 17 years). Persistency of pain in the MCP-1 joint was reported by 11 patients. Postoperative averaged score was 3.75 on DASH and 44.96 on SF36, respectively. The average grip and pinch strength was 32.7 kg and 8.37 kg, respectively. Predictive factors of postoperative deficits were delay of surgery of > 3 weeks (OR 10.72, p 0.017) and palmar subluxation prior to surgery (OR 8.86, p 0.019).
CONCLUSION
Long-term follow-up has proven that surgical repair of RCL enables the patient to regain adequate stability and strength of the MCP-1 joint and minimizes disability. Predictive risk factors of pain persistency after surgery are surgical delay and palmar subluxation of the MCP-1 joint.
背景
拇指桡侧副韧带（RCL）在稳定第一掌指关节（MCP-1）方面起着重要作用。RCL 损伤较为罕见，目前文献中的治疗建议也不一致。本研究旨在报告 RCL 撕裂伤手术后的长期结果，并确定治疗失败的预后危险因素。
方法
本回顾性单中心队列研究纳入了 1998 年 10 月至 2019 年 10 月期间接受 RCL 撕裂伤手术治疗的患者。在随访时，评估患者的疼痛、活动度和力量以及肩、臂和手的残疾程度（DASH）和健康调查简表 36（SF36）问卷。最后，确定术后缺陷的预测因素。
结果
43 例患者符合纳入标准。中位年龄为 43.5 岁（范围 18-80 岁）。最常见的损伤机制是跌倒或撞击。46.5%（20/43）的患者存在骨撕脱。从受伤到手术的时间为 12 天（0-276 天）。我们的患者中术中发现 1 例类似 Stener 的病变。手术后，MCP-1 关节稳定。平均随访时间为 5.3 年（1 个月至 17 年）。11 例患者报告 MCP-1 关节持续性疼痛。术后 DASH 平均评分为 3.75，SF36 平均评分为 44.96。平均握力和捏力分别为 32.7kg 和 8.37kg。术后缺陷的预测因素为手术延迟超过 3 周（OR 10.72，p=0.017）和术前掌侧半脱位（OR 8.86，p=0.019）。
结论
长期随访证实，RCL 撕裂伤的手术修复使患者恢复了 MCP-1 关节的充分稳定性和力量，并最大限度地减少了残疾。手术后疼痛持续存在的预测危险因素是手术延迟和 MCP-1 关节的掌侧半脱位。
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