拇指尺侧副韧带急性完全断裂的处理
The management of acute complete ruptures of the ulnar collateral ligament of the thumb.
作者信息
Mikhail Mark, Riley Nicholas, Rodrigues Jeremy, Carr Elaine, Horton Robin, Beale Nicholas, Beard David J, Dean Benjamin J F, Clubb Lucy, Johnstone Alan, Lawrie David, Imam Mohamed, Joyce Sarah, Ankarth Sudhi, Capp Rachel, Dayananda Kathryn, Gape Nick, Trickett Ryan, Bremner-Smith Alice, Chan Carol, Eckersley Rupert, Horwitz Maxim, Jatan Anita, Lumsdaine William, McArthur Gordon, Mee Sarah, Banks Louisa, Dean Sally, Dehbozorgi Sasan, Green Kate, Meh Sonu, Fawkes Francesca, Rooker Jemma, Bell Hannah, Vaghela Kalpesh, Fournier Katia, Kennedy Donna, Li Lily, Srinivasan Suresh, Gamble David, Gerakopoulos Efstratios, Groves Jordyn, Jackson Thomas, Karuppaiah Karthik, Maltby Amy, Nair Anjali, Reichert Ines, Bains Robert, Mariathas Chrishan, Reilly Fiona, Sharpe Laura, Wildin Clare, Feeney Michael, Kulkarni Avadhut, Sharma Vikas, Flaherty Sarah, Gough Anthony, Hamlin Katharine, King Lorraine, Law Cherry, Johnson Simon, Svee Cyndi, Khan Yasmeen, Rodgers Sarah, Storey Phil, Dean Ben, Sander-Danby Lizelle, Shields Karen, Torkington Matthew, Blackshaw Rachel, Chaudhry Tahseen, Jordan Lisa, Wu Feiran, Clarke David, Robinson Elena, Thumbadoo Ruben, Parkinson Miriam, Sharpe Kevin, Allen Matt, Poulter Rob, Currie Jamie, Stone Oliver, Cliff Nicola, Duckworth Andrew, Cowey Alex, Crossfield James, Giddins Grey, Heath Robyn, Langdon Ilana, Mgbemena Lydia, Mills Rebecca, Pickering Greg, Sheriff Mark, McDonough Andrew, Naqui Zaf, Lyons Nicole, Reay Emma, Taylor Tracey, Bates Michelle, Eastwood Gillian, McLoughlin-Symon Iain, Ramesh Ashwanth, Chan James, Govilkar Prashant, Shirley Rebecca, Upson Claire, Sajid Soha, Carr Elaine, Langley Claire, Higgins Joanna, Armstrong Alexander, Gujral Sameer, Howe Aimee, Ip Mina, Thornsby Janette, Slade Robert, Knowles Laura, Lipscombe Stephen, Goggins Theresa, Talwalkar Sumedh
机构信息
Oxford University Hospitals NHS Trust, Oxford, UK.
Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK.
出版信息
Bone Jt Open. 2024 Aug 22;5(8):708-714. doi: 10.1302/2633-1462.58.BJO-2024-0062.R1.
AIMS
Complete ruptures of the ulnar collateral ligament (UCL) of the thumb are a common injury, yet little is known about their current management in the UK. The objective of this study was to assess the way complete UCL ruptures are managed in the UK.
METHODS
We carried out a multicentre, survey-based cross-sectional study in 37 UK centres over a 16-month period from June 2022 to September 2023. The survey results were analyzed descriptively.
RESULTS
A total of 37 centres participated, of which nine were tertiary referral hand centres and 28 were district general hospitals. There was a total of 112 respondents (69 surgeons and 43 hand therapists). The strongest influence on the decision to offer surgery was the lack of a firm 'endpoint' to stressing the metacarpophalangeal joint (MCPJ) in either full extension or with the MCPJ in 30° of flexion. There was variability in whether additional imaging was used in managing acute UCL injuries, with 46% routinely using additional imaging while 54% did not. The use of a bone anchor was by far the most common surgical option for reconstructing an acute ligament avulsion (97%, n = 67) with a transosseous suture used by 3% (n = 2). The most common duration of immobilization for those managed conservatively was six weeks (58%, n = 65) and four weeks (30%, n = 34). Most surgeons (87%, n = 60) and hand therapists (95%, n = 41) would consider randomizing patients with complete UCL ruptures in a future clinical trial.
CONCLUSION
The management of complete UCL ruptures in the UK is highly variable in certain areas, and there is a willingness for clinical trials on this subject.
目的
拇指尺侧副韧带（UCL）完全断裂是一种常见损伤，但目前英国对其治疗情况知之甚少。本研究的目的是评估英国对UCL完全断裂的治疗方式。
方法
在2022年6月至2023年9月的16个月期间，我们在英国37个中心开展了一项基于调查的多中心横断面研究。对调查结果进行描述性分析。
结果
共有37个中心参与，其中9个是三级转诊手部中心，28个是地区综合医院。共有112名受访者（69名外科医生和43名手部治疗师）。对手术决策影响最大的因素是在掌指关节（MCPJ）完全伸展或屈曲30°时，对其施压缺乏明确的“终点”。在急性UCL损伤的处理中，是否使用额外影像学检查存在差异，46%的中心常规使用额外影像学检查，而54%的中心不使用。到目前为止，使用骨锚是重建急性韧带撕脱最常见的手术选择（97%，n = 67），3%（n = 2）的中心使用经骨缝合。保守治疗患者最常见的固定时间是六周（58%，n = 65）和四周（30%，n = 34）。大多数外科医生（87%，n = 60）和手部治疗师（95%，n = 41）会考虑在未来的临床试验中对UCL完全断裂的患者进行随机分组。
结论
在英国，UCL完全断裂的治疗在某些方面差异很大，并且愿意针对该主题开展临床试验。
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