关节融合术治疗拇指第一腕掌关节炎的疗效

目的 探讨关节融合术治疗拇指第一腕掌关节炎的临床疗效.方法 选择自2011年5月至2017年4月,通过关节融合治疗第一腕掌关节炎患者31例,男8例,女23例,年龄在42～55岁,平均48岁.术前依据影像学Eaton?Little分期:Ⅱ期5例,Ⅲ期26例.所有患者均行克氏针固定.术后定期复查X线片观察第一腕掌关节融合情...     

大多角骨切除加桡侧腕屈肌悬吊治疗退行性第一腕掌关节炎

目的 评价大多角骨切除加桡侧腕屈肌悬吊治疗退行性第一腕掌关节炎的疗效.方法 采用大多角骨切除加桡侧腕屈肌悬吊术治疗退行性第一腕掌关节炎8例,按Krimmer腕关节评分法评价术后腕关节功能恢复,患者自我功能评价表(DASH问卷调查表)评价手术前后生活质量的改善状况.方果 术后随访8～26个月,平均15个月,包括手术前后腕掌关节疼痛程度、腕掌关节活动度、握力以及X线片检查.第一腕掌关节疼痛值术前为(5.6±2.2),术后为(1.6±1.0);拇指内收外展活动度术前为(32.0±10.0)°,术后为(58.0±13.0)°;拇指屈伸活动度术前为(20.0±11.0)°,术后为(43.0±13.0)°;握力术前为(16.5±3.9)ks,术后为(25.0±8.3)ks;捏力术前为(2.0±0.9)ks,术后为(3.2±1.3)ks.Krimmer评分值术前为(48.0±19.0)分,术后为(85.0±23.0)分;其中优5例,良2例,中1例.DASH值术前为(52.0±20.0)分,术后为(21.0±14.0)分,DASH调查表结果显示术后手部灵巧,动作恢复良好,但从事重体力劳动有部分功能受限.方论 大多角骨切除加桡侧腕屈肌腱悬吊可减轻疼痛、改善第一腕掌关节功能,是治疗退行性第一腕掌关节炎的有效手段,但从事重体力劳动时仍有部分功能受限.     

腕关节融合钢板内固定术的临床疗效

目的评价腕关节融合钢板内固定术的临床疗效。方法2000年7月-2004年12月，采用腕关节融合钢板内固定术治疗创伤性腕关节炎21例。随访内容包括腕关节疼痛程度、手指关节活动度、握力和x线片。根据Buck—Gramcko／Lohrnanrm评分表评价腕关节总体功能，DASH调查表评价腕关节融合术对患者日常活动及生活质量的影响。结果术后21例获得随访，平均随访时间为20个月。术后患侧腕部疼痛值平均为1．5（术前4．5），12例掌指关节和lO例拇指指间关节出现轻微背伸功能障碍，腕部握力为30kg（健侧为38kg）。x线片示腕关节全部骨性融合。Buck—Gramcko／Lohmanrm评分值为8．7，其中优5例、良10例，中6例。DASH值为32，DASH调查表结果表明腕关节融合术后部分日常活动受限。结论腕关节融合钢板内固定成功率高，腕关节疼痛明显减轻，但术后腕关节部分功能丧失。     

部分桡侧腕屈肌腱瓣修复陈旧性第一腕掌关节部位

第一腕掌关节脱位为第一掌骨受到轴向加尺偏暴力使掌骨基底部向背侧、桡侧近端移位所致，常常伴有韧带断裂，招致关节不稳，严重影响拇指对掌及外展活动。作者自1999年始采用部分桡侧屈腕肌腱瓣修复陈旧性第一腕掌关节脱位患者8例，取得满意疗效，报道如下。１资料与方法１．１一般资料本组8例，男性，年龄18～25岁。受伤原因：击打沙袋3例，擒拿格斗4例，摔伤1例。受伤时间：3个月～1年，平均6.7个月。所有病例均经过门诊复诊。１．２手术方法于前臂腕掌桡侧作“S”形切口，自腕掌横纹向近端延伸，长约10cm，切开皮肤、皮下及前臂深筋膜，…     

第一腕掌关节炎手术治疗进展

第一腕掌关节是骨关节炎最常见的发病部位之一,早期药物治疗效果欠佳.50多年前提出的去神经治疗方法主要是针对腕背侧疼痛,但解决不了拇指功能问题.近年出现的腕掌关节固定术,可保留抓握力量,恢复拇指对掌、拇外展功能,但引起骨不连较多,假体植入后早期并发症概率高.目前认为韧带重建关节成形术疗效可靠,创伤小,操作简单,取材和转位方便,可能有临床推广价值.     

关节融合术治疗拇指腕掌关节炎18例长期随访观察

目的:观察微型钢板关节融合术治疗拇指腕掌关节炎的远期疗效。方法:回顾性分析自2005年1月至2015年12月我们采用微型钢板融合术治疗的18例拇指腕掌关节炎患者临床资料及影像学资料。影像学评估指标包括：骨愈合情况,舟、大、小多角骨(scaphoid-trapezium-trapezoid,STT)周围关节炎。临床疗效评...     

Scheker成型术治疗第五腕掌关节损伤后创伤性关节炎疗效观察

目的观察Scheker成型术治疗第五腕掌关节损伤后创伤性关节炎的疗效。方法选取2015-01—2016-01间收治的22例第五腕掌关节损伤后创伤性关节炎患者,均实施Scheker腕掌关节成型术治疗。比较术前、术后影像学及临床评分结果;观察第五掌骨高度、患手握力及掌指关节活动度。结果术后随访6个月,植骨融合时间为(6.4±0.9)周。术前握力(33.2±11.9)kg、术后握力(44.8±13.1)kg,差异有统计学意义(P0.05);术前掌指关节活动度(89.1±2.9)°、第五掌骨高度(53.3±3.1)mm,术后分别为(89.2±2.7)°和(54.2±3.0)mm,差异均无统计学意义(P0.05)。结论 Scheker腕掌关节成型术治疗第五腕掌关节损伤后创伤性关节炎,可显著改善患者术后握力,效果肯定。     

第一腕掌关节损伤的治疗

自１９８６～１９９５年,我科收治第一腕掌关节损伤（包括Ｂｅｎｎｅｔ骨折,腕掌关节脱位,创伤性关节炎）４７例,现报告如下。临床资料本组４７例中,男３７例,女１０例;年龄２０～５３岁。Ｂｅｎｎｅｔ骨折３５例,其中粉碎骨折２例,就诊距受伤时间１～３０天,有...     

部分腕骨融合术对腕关节生物力学影响的实验研究

目的探讨部分腕骨融合术后腕关节的活动范围、压力负荷及对腕关节生理状态的影响。方法选用12例新鲜腕关节标本随机分为3组,A组舟大小融合术;B组舟骨三角骨切除+头月融合术;C组四角融合+舟骨切除术。通过CSS-44020系列生物力学试验机,用100N力,以5mm/s的速度分别牵引腕关节被动掌屈、背伸、尺偏和桡偏,并测量A、B、C3组标本的活动角度。然后,于腕关节内放置压敏片,用自制的实验架将腕关节固定于中立位,以5N/s的压速对腕关节施压至200N,维持60s后测量压敏片上各组标本的受力面积和压力负荷。结果(1)活动范围A组掌屈(68.4±5.2)°(x-±s,下同)、背伸(51.5±4.6)°、尺偏(24.5±2.3)°、桡偏(15.7±3.4)°。B组掌屈(64.5±7.1)°、背伸(60.0±5.2)°、尺偏(42.4±3.2)°、桡偏(26.9±5.2)°。C组掌屈(61.9±6.6)°、背伸(54.9±5.3)°、尺偏(27.1±3.9)°、桡偏(17.0±4.9)°。(2)腕关节的受力面积A组为(265.00±8.97)mm2。B组为(125.81±5.97)mm2。C组为(164.00±8.43)mm2。(3)负荷压力A组为(53.87±3.07)N/cm2。B组为(112.86±0.74)N/cm2。C组为(55.28±5.11)N/cm2。结论舟大小融合术、舟骨切除+四角融合术对腕关节应力负荷的影响与正常腕关节相比变化不大,而舟三角骨切除+头月融合术对腕关节的影响较大,其应力负荷的增加明显超出了正常腕关节所承受的压力负荷。     

Results of Mannerfelt wrist arthrodesis for rheumatoid arthritis in relation to the position of the fused wrist

Purpose

The wrist is involved early in rheumatoid arthritis and is often severely affected. A stable wrist is crucial to good hand function, which often necessitates a fusion. One of the most commonly used techniques in rheumatoid patients is the Mannerfelt arthrodesis. In this retrospective study the outcome and the patient’s subjective satisfaction are presented and compared to other techniques. Also the influence of the position of the wrist following a fusion procedure is analysed.

Methods

Thirty-four wrists were retrospectively analysed using radiological measurements, functional scores such as the Disabilities of the Arm, Shoulder and Hand (DASH) and a pain assessment. The objective function of the hand with the fused wrist was assessed.

Results

In 92.6 % of wrists the patients rated their satisfaction as good or excellent. The mean DASH score post-operatively was 63.3. Of the wrists, 17 were fixed in a median flexed position of 13° and 17 wrists in a median extended position of 8°. There was no statistically significant correlation between the position of the wrist and the satisfaction or objective function. The rate of fusion was 94.1 %.

Conclusions

The Mannerfelt arthrodesis achieves good results and provides a high rate of satisfaction and pain relief in our study. It has major advantages compared to other wrist fusion techniques in the rheumatoid patient. We could not show clear statistical evidence for better results in either a flexed or an extended position, but the ratings of the patients indicated better subjective results with a slightly extended position of the arthrodesis.     

Partial arthrodesis of the wrist: An investigation in cadavers

Partial arthrodesis of the wrist was performed on six cadavers in order to study the residual excursion of the wrist. Arthrodesis between the radius and scaphoid left 40 per cent extension/flexion and 61 per cent radial/ulnar deviation. Arthrodesis between the radius, scaphoid and lunate left 36 per cent extension/flexion and 59 per cent radial/ulnar deviation. Arthrodesis between the capitate, scaphoid and lunate left 59 per cent extension/flexion and 91 per cent radial/ulnar deviation.     

Wrist arthrodesis using a Synthes wrist fusion plate

Thirty-nine patients were retrospectively reviewed after a wrist arthrodesis using a Synthes wrist fusion plate and iliac crest bone graft. Information was obtained from review of patient files, a questionnaire to assess pain, function and work status, and clinical assessment of grip strength, forearm rotation and fingers motion. All wrist fusions united except that the index carpometacarpal joint failed to unite in one patient. Thirty-seven patients were satisfied with the procedure, noting a reduction in wrist pain after fusion, but all reported some limitation of function. The wrist fusion plate was removed in six patients and a further four patients experienced minor symptoms over the dorsal aspect of the middle finger metacarpal.     

Scaphoid Excision and Limited Wrist Fusion: A Comparison of K-Wire and Circular Plate Fixation

The purpose of this study was to compare the clinical outcome, union rate, and complications of a consecutive series of Scaphoid excision and limited wrist arthrodesis performed by a single surgeon using distal radius bone graft and K-wires or circular plate fixation. A sequential series of ten patients(11 wrists) who were stabilized with temporary K-wires were compared to 11 patients (11 wrists) who were stabilized with a circular plate. Minimum follow-up was 1 year. One patient in the K-wire group was converted to a wrist fusion. Six of the remaining ten patients in the K-wire fixation group and 8 of the 11 patients in the circular plate fixation group returned for the following blinded evaluations: Quick DASH, analog pain scale, range of motion, grip and pinch strength, plain x-ray, and multi-detector computed tomography evaluation. One non-union occurred in the K-wire group. There were no non-unions in the circular plate fixation group. There was no difference in any of remaining measures or rate of complications. This study shows that equivalent results can be obtained using circular plate fixation compared to K-wires when equivalent bone graft source and fusion technique are used. If K-wire removal requires a return to the OR, circular plate fixation is more cost-effective.     

舟骨、大、小多角骨局限性腕骨融合术治疗舟骨旋转性半脱位

目的：介绍治疗舟骨旋转性半脱位（rotatory subluxation of the scaphoid,RSS)的新术式。方法：根据临床表现及病因，舟骨旋转性半脱位分为5型，I型（动态前期型）1例，Ⅱ型（动态型）2例，Ⅲ型（静态型）7例，Ⅳ型（退行性型）3例，Ⅴ（继发型）5例。18例患者入院后均行舟骨、大、小多角骨局限性腕骨融合术（scapho-trapezio-trapezoeid arthrodesis,STT融合术）。结果：术后随访个月－3年，18例的舟骨旋转性半脱位均得到纠正，并获得满意的骨融合。腕痛均消失，握力平均恢复至健侧的90％，腕关节活动范围平均恢复至侵侧的62％。结论：舟骨、大、小多角骨局限性腕骨融合术是一种治疗慢性、静态性舟骨旋转性半脱位的可靠、有效的疗法。     

部分腕骨融合术治疗腕部疾患进展

目的 综述近年来国内外有关部分腕骨融合治疗腕部疾患及其实验研究进展。方法 广泛查阅相关文献,对部分腕骨融合的临床应用效果和实验研究进展分析和综合。结果 部分腕骨融合既能解除腕关节疼痛,又能稳定和保留一定范围活动度。结论 采用部分腕骨融合术治疗腕部疾患,只要适应证和手术方法选择合适,应当首选。     

Effect of static wrist position on grip strength

Background:

Grip strength after wrist arthrodesis is reported to be significantly less than normal. One of the reasons suggested for this decrease in grip strength is that the arthrodesis was performed in a suboptimal position. However, there is no consensus on the ideal position of wrist fusion. There is a paucity of studies evaluating the effect of various fixed positions of the wrist on grip strength and therefore, there is no guide regarding the ideal position of wrist fusion. The authors′ aim was to determine the grip strength in various fixed positions of the wrist and subsequently to find out in which position of wrist fusion the grip strength would be maximal.

Materials and Methods:

One hundred healthy adults participated in the study. For the purpose of this study, the authors constructed splints to hold the wrist in five different fixed positions: 45, 30 and 15 degrees of wrist extension, neutral and 30 degrees of wrist flexion. The grip strength in all the participants was measured bilaterally, first without a splint and then with each splint sequentially.

Results:

The average grip strength without the splint was 34.3 kg for right and 32.3 kg for the left hand. Grip strength decreased by 19–25% when the wrist was splinted. The maximum average grip strength with a splint on was recorded at 45 degrees of extension (27.9 kg for right and 26.3 kg for left side). There was a gradual increase in the grip strength with increase in wrist extension but the difference was not statistically significant (P = 0.29). The grip strength was significantly less in flexed position of the wrist (P < 0.001).