Pillukat Thomas, Heitzmann Wolfram, Kalb Karlheinz, Windolf Joachim, van Schoonhoven Jörg
Klinik für Handchirurgie, Von Guttenbergstr. 11, 97616, Bad Neustadt an der Saale, Deutschland.
Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland.
Oper Orthop Traumatol. 2021 Jun;33(3):200-215. doi: 10.1007/s00064-021-00712-z. Epub 2021 Jun 8.
Resuspension of the first metacarpal bone using the extensor carpi radialis longus muscle tendon. Prevention of contact between the first metacarpal bone and adjacent bones (scaphoid, trapezoideum, second metacarpal bone). Preservation of motion.
Pain after preceeding resectional arthroplasty due to proximalisation of the first ray. Radiologically demonstrated contact between the base of the first metacarpal bone and adjacent bones (scaphoid, trapezoideum, second metacarpal bone). Instability of the first ray at the site of the suspension.
Proven specific reasons: neuropathical complaints and dysaesthesia in the region supplied by the superficial branch of the radial nerve, tendinitis of the flexor carpi radialis tendon etc. SURGICAL TECHNIQUE: Distalisation of the first ray after mobilisation and debridement at the base of the first metacarpal bone with resection of scar tissue, Resection of the pre-existing tendon plasty and contouring the base of the first metacarpal bone with removal of osteophytes. Interposition of tendon material between the base of the first and second metacarpal bones.
Immobilisation in a forearm cast including the thumb metacarpophalangeal joint for 6 weeks.
Of 21 patients treated using this procedure, 15 (13 women, 2 men, average age 59 (51-70) years) were evaluated retrospectively on average 4 (2-10) years postoperatively. Opposition of the thumb was nearly normal. Grip strength and strength of pinch grip did not differ significantly from the contralateral side. Pain at rest and exercise (evaluated by a visual analogue scale from 0-10) was postoperatively significantly reduced. On plain X‑rays the distance between the base of the first metacarpal bone and the distal scaphoid pole was significantly increased as a sign of a successful distalisation. Ultimately, 12 patients postoperatively returned to work, 10 to their original occupation. No patient required additional procedures.
使用桡侧腕长伸肌腱对第一掌骨进行再悬吊。防止第一掌骨与相邻骨骼（舟骨、大多角骨、第二掌骨）之间接触。保留活动度。
先前切除性关节成形术后因第一掌骨近端移位导致的疼痛。放射学显示第一掌骨基底与相邻骨骼（舟骨、大多角骨、第二掌骨）之间存在接触。第一掌骨在悬吊部位不稳定。
已证实的特定原因：桡神经浅支所支配区域的神经病理性疼痛和感觉异常、桡侧腕屈肌腱炎等。
在第一掌骨基底进行松解和清创后将第一掌骨向远端移位，切除瘢痕组织，切除原有的肌腱成形术，去除骨赘并修整第一掌骨基底。在第一和第二掌骨基底之间置入肌腱材料。
使用包括拇指掌指关节的前臂石膏固定6周。
采用该手术治疗的21例患者中，15例（13例女性，2例男性，平均年龄59岁（51 - 70岁））在术后平均4年（2 - 10年）进行了回顾性评估。拇指对掌功能几乎正常。握力和捏力与对侧相比无显著差异。静息和运动时的疼痛（采用0 - 10视觉模拟评分法评估）术后显著减轻。在普通X线片上，第一掌骨基底与舟骨远端极之间的距离显著增加，表明远端移位成功。最终，12例患者术后恢复工作，10例恢复原职业。无患者需要额外手术。
