拇指掌指关节置换+指间关节融合术对类风湿关节炎拇指纽扣畸形的矫形效果观察
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摘要
目的探讨拇指掌指关节置换+指间关节融合术对类风湿关节炎拇指纽扣畸形的治疗效果。方法2016年1月-2017年6月,对5例类风湿关节炎(Rheumatoid Arthritis,RA)导致的纽扣畸形拇指的掌指关节行Swanson假体置换术、指间关节融合术,术后1个月通过Carroll手功能试验评分法评定患者的手部功能,并观察患指的对掌功能和患者对患指外观的满意度。结果术后5例伤口均获得Ⅰ期愈合,随访6～12个月未发生假体移位、假体断裂、假体周围骨折等并发症。术后1个月,患者的Carroll评分明显升高,对掌功能损害值明显下降,且患者对拇指外观的满意度评分明显升高。结论拇指掌指关节置换+指间关节融合术可改善RA拇指纽扣畸形患者的拇指对掌功能,从而提高手部整体功能,且患者对畸形矫正效果满意。
Objective To investigate the therapeutic effect of metacarpophalangeal replacement combined with interphalangeal joint fusion on thumb button deformity in rheumatoid arthritis patients. Methods Five patients with rheumatoid arthritis-induced thumb boutonniere deformity were treated by metacarpophalangeal replacement using swanson prosthesis combined with interphalangeal joint fusion.The patient's hand function was assessed by Carro II test score 1 month after operation, and the opposition function of the affected finger and the patient's satisfaction with the appearance of the finger were investigated as well. Results All the patients underwent first-stage healing in the operative wounds.No complications such as prosthesis displacement, prosthesis rupture, and periprosthetic fracture occurred during the following-up of 6-12 months. One month after surgery, the patient's Carro II score was significantly increased, the opposition function impairment value decreased significantly, and the patient's satisfaction score on the appearance of the thumb was significantly increased. Conclusion Metacarpophalangeal joint replacement combined with interphalangeal joint fusion can improve the thumb opposition function of RA patients with thumb button deformity, thus improve the overall function of the hand, and the patients are satisfactory with the orthopaedic effect.
Objective To investigate the therapeutic effect of metacarpophalangeal replacement combined with interphalangeal joint fusion on thumb button deformity in rheumatoid arthritis patients. Methods Five patients with rheumatoid arthritis-induced thumb boutonniere deformity were treated by metacarpophalangeal replacement using swanson prosthesis combined with interphalangeal joint fusion.The patient's hand function was assessed by Carro II test score 1 month after operation, and the opposition function of the affected finger and the patient's satisfaction with the appearance of the finger were investigated as well. Results All the patients underwent first-stage healing in the operative wounds.No complications such as prosthesis displacement, prosthesis rupture, and periprosthetic fracture occurred during the following-up of 6-12 months. One month after surgery, the patient's Carro II score was significantly increased, the opposition function impairment value decreased significantly, and the patient's satisfaction score on the appearance of the thumb was significantly increased. Conclusion Metacarpophalangeal joint replacement combined with interphalangeal joint fusion can improve the thumb opposition function of RA patients with thumb button deformity, thus improve the overall function of the hand, and the patients are satisfactory with the orthopaedic effect.
引文
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[8]夏冒李,李娟,吴婧,等.类风湿关节炎2010ACR/EULAR与1987ACR诊断分类标准的诊断效能比较研究[J].热带医学杂志,2013,13(5):606-610.
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[10]朱婵,易南,石梦娜,等.功能训练联合自制手屈曲训练带治疗手背部烧伤后瘢痕挛缩的效果观察[J].中华烧伤杂志,2017,33(7):426-430.
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[12]王凌椿,陈雁西,张建平,等.人工掌指关节置换术治疗类风湿关节炎手部畸形效果观察[J].山东医药,2015,55(4):88-89.
[13]张军,薛宏斌,袁新建,等.人工掌指关节置换、右髂骨取骨植骨功能再造手术治疗掌骨头粉碎性骨折伴骨质缺损一例报告[J].延安大学学报:医学科学版,2013,11(2):37-38.
[14]索岩,张展,杨光,等.微型钛板螺钉与交叉克氏针融合近指间关节的比较研究[J].中华手外科杂志,2012,28(5):290-291.
[15]宋永焕,林大木,丁健,等.3种手术方法融合手指近侧指间关节的疗效比较[J].中国骨与关节损伤杂志,2014,29(11):1163-1164.
[16]刘会仁,项力源,张艳茂,等.关节融合在拇指对掌功能重建中的应用[J].中华手外科杂志,2004,20(4):236-237.
[17]Singh M,Sisk G,Carty M,et al.Functional Outcomes after Bilateral Hand Transplantation:A 3.5-Year Comprehensive Follow-Up[J].Plastic&Reconstructive Surgery,2016,137(1):185.
[18]韩素琴,黄耀鹏,潘佳栋,等.保留供区足趾长度的拇指缺损再造术的围手术期护理[J].中华显微外科杂志,2016,39(3):305-306.
[19]田文,杨勇.手部先天畸形的治疗原则应兼顾手部的外观和功能[J].中国骨与关节损伤杂志,2017,6(4):241-243.
[2]Simon TA,Thompson A,Gandhi KK,et al.Incidence of malignancy in adult patients with rheumatoid arthritis:a meta-analysis[J].Arthritis Research&Therapy,2015,17(1):1-10.
[3]洪光祥.手部类风湿性关节炎的手术治疗[J].实用手外科杂志,2007,21(3):131-132.
[4]潘大洋,段宜强,秦海泉,等.掌指关节置换治疗手类风湿性关节炎1例报告[J].贵州医药,2015,39(3):271-272.
[5]隋海明,丛海波,杜全红,等.人工关节置换重建掌指关节功能的远期随访[C].山东省医学会手足外科第七次学术会议,2013.
[6]张凌洲,缪道一,姜文辉.人工关节置换与自体髂骨取骨修复掌指关节置换疗效分析[J].浙江中西医结合杂志,2015,25(5):481-483.
[7]景晓虎,刘彩霞,沈强,等.锤状指畸形的临床治疗[J].实用手外科杂志,2015,29(2):206-207.
[8]夏冒李,李娟,吴婧,等.类风湿关节炎2010ACR/EULAR与1987ACR诊断分类标准的诊断效能比较研究[J].热带医学杂志,2013,13(5):606-610.
[9]胡刚,贾学峰,李向荣.手部功能锻炼在58例手外伤患者中的疗效分析[J].南通大学学报(医学版)医学版,2016,36(5):494-495.
[10]朱婵,易南,石梦娜,等.功能训练联合自制手屈曲训练带治疗手背部烧伤后瘢痕挛缩的效果观察[J].中华烧伤杂志,2017,33(7):426-430.
[11]顾玉东.拇指对掌功能的定义与检测[J].中华手外科杂志,2011,27(5):258-259.
[12]王凌椿,陈雁西,张建平,等.人工掌指关节置换术治疗类风湿关节炎手部畸形效果观察[J].山东医药,2015,55(4):88-89.
[13]张军,薛宏斌,袁新建,等.人工掌指关节置换、右髂骨取骨植骨功能再造手术治疗掌骨头粉碎性骨折伴骨质缺损一例报告[J].延安大学学报:医学科学版,2013,11(2):37-38.
[14]索岩,张展,杨光,等.微型钛板螺钉与交叉克氏针融合近指间关节的比较研究[J].中华手外科杂志,2012,28(5):290-291.
[15]宋永焕,林大木,丁健,等.3种手术方法融合手指近侧指间关节的疗效比较[J].中国骨与关节损伤杂志,2014,29(11):1163-1164.
[16]刘会仁,项力源,张艳茂,等.关节融合在拇指对掌功能重建中的应用[J].中华手外科杂志,2004,20(4):236-237.
[17]Singh M,Sisk G,Carty M,et al.Functional Outcomes after Bilateral Hand Transplantation:A 3.5-Year Comprehensive Follow-Up[J].Plastic&Reconstructive Surgery,2016,137(1):185.
[18]韩素琴,黄耀鹏,潘佳栋,等.保留供区足趾长度的拇指缺损再造术的围手术期护理[J].中华显微外科杂志,2016,39(3):305-306.
[19]田文,杨勇.手部先天畸形的治疗原则应兼顾手部的外观和功能[J].中国骨与关节损伤杂志,2017,6(4):241-243.