Kapandji T G, Kapandji A I
Clinique de l'Yvette, Longju-Meau.
Ann Chir Main Memb Super. 1993;12(4):263-74. doi: 10.1016/s0753-9053(05)80025-0.
Systematic x-rays in specific views and maximal amplitude of 330 trapezo-metacarpal joints in patients presenting with hand lesions has enabled us to define some original radiological parameters: the angle of the trapezium, the slope angle of the trapezium in anteversion and retroversion, trapezium mobility, the subluxation coefficient and the contact arc of the first metacarpal (M1) on the trapezium, defective reintegration of the base of the first metacarpal into the curve of the trapezium on AP and lateral views and the length of the intermetacarpal ligament. Statistical analysis, using analysis of variance, Chi-square test and correlation tests have demonstrated some correlations between all of these parameters allowing us to propose a pathophysiological hypothesis. In particular, this study emphasised the important role of a failure of the intermetacarpal ligament in the pathogenesis of proximal osteoarthritis of the thumb. Long before the onset of the well known signs of osteoarthritis, narrowing of the joint line and osteophytes, precursor radiological signs can be detected: loosening of the intermetacarpal ligament, excessive mobility of the trapezium, and poor reintegration of the base of M1 in the trapezium curve on AP and lateral films should now allow the early diagnosis and the proposal of preventive operations, such as intermetacarpal ligamentoplasty, reorientation osteotomies of the trapezium facet when the trapezium angle is too wide or new surgical techniques on the abductor carpi radialis, an almost constant expansion of the abductor pollicis longus on the trapezium.
对出现手部病变的患者进行特定视图的系统性X线检查以及对330个大多角骨-掌骨关节的最大幅度检查，使我们能够确定一些原始的放射学参数：大多角骨角度、大多角骨在掌前和掌后倾时的倾斜角度、大多角骨活动度、半脱位系数以及第一掌骨（M1）在大多角骨上的接触弧、在前后位和侧位片上第一掌骨基底融入大多角骨曲线的情况欠佳以及掌间韧带的长度。使用方差分析、卡方检验和相关性检验进行的统计分析表明，所有这些参数之间存在一些相关性，这使我们能够提出一种病理生理假设。特别是，本研究强调了掌间韧带功能障碍在拇指近端骨关节炎发病机制中的重要作用。在骨关节炎的众所周知的体征（关节间隙变窄和骨赘）出现之前很久，就可以检测到放射学前兆体征：掌间韧带松弛、大多角骨过度活动以及在前后位和侧位片上M1基底在大多角骨曲线中的重新整合不佳，现在这些情况应有助于早期诊断并提出预防性手术建议，例如掌间韧带成形术、当大多角骨角度过宽时对大多角骨小面进行重新定向截骨术，或者对桡侧腕短伸肌采用新的手术技术，即对大多角骨上的拇长展肌进行几乎恒定的扩张。
