摘要目的 探讨表面置换型手指人工关节在治疗关节病变中的应用及临床疗效.方法 自2013年4月至2014年3月,我们共收治15例手指关节病变患者,行人工关节表面置换术.术前诊断为骨性关节炎2例,类风湿关节炎2例,创伤性关节炎11例.根据术前和术后视觉模拟评分(visual analogue scale,VAS)、握力、关节主动活动度和总体手功能DASH量表评分等参数来评价疗效.结果 术后所有患者伤口工期愈合,随访时间为12～20个月,平均14.5个月.患者关节VAS从术前(6.3±1.0)分降低到末次随访时(1.5±0.8)分,差异有统计学意义(P＜0.05);患手握力从术前(11.0±2.4) kg增加到末次随访时(12.5±3.5) kg,差异无统计学意义(P＞0.05).近指间关节主动活动度从术前(30.0±11.2)°提高到末次随访时(45.2± 14.8)°,差异有统计学意义(P＜0.05);掌指关节主动活动度从术前(21.7±7.6)°提高到末次随访时(25.6±9.3)°,差异无统计学意义(P＞0.05).总体手功能DASH量表评分从术前(46.3±9.6)分降低到末次随访时(30.9±11.6)分,差异有统计学意义(P＜0.05).截至末次随访,1例中指近指间关节和1例拇指掌指关节发生假体脱位,无假体断裂、假体周围骨折和假体感染等并发症.结论 手指关节表面置换术是治疗手部关节疼痛、关节僵直,纠正关节畸形的有效方法,近期疗效满意,但对手术入路的选择和周围瘢痕粘连组织的处理仍需进一步探索.

abstractsObjective To investigate the clinical outcomes of applying the anatomical resurfacing implant in treating joint diseases and improving hand function.Methods A total of 15 cases with proximal interphalangeal (PIP) joint or metacarpophalangeal (MP) joint diseases were treated with arthroplasty and resurfacing artificial joint replacement from April 2013 to March 2014.There were 2 patients with primary osteoarthritis,2 patients with rheumatoid arthritis and 11 patients with post-traumatic arthritis.Pre and postoperative pain was evaluated by the visual analogue scale (VAS).Grip strength,active range of motion of the joints and DASH scores were measured as well to assess the treatment outcomes.Results Primary wound healing was achieved in all the patients.Postoperative follow-up period ranged from 12 to 20 months,with an average of 14.5 months.Pain was significantly alleviated from a 6.3 VAS score preoperatively to a 1.5 score at the latest follow-up (P ＜ 0.05).The average grip strength increased from (11.0 ± 2.4) kg preoperatively to (12.5 ± 3.5) kg at the latest follow-up (P ＞ 0.05).PIP joint active range of motion increased from (30.0 ± 11.2)° preoperatively to (45.2 ± 14.8)° at last follow-up,the difference being statistically significant (P ＜ 0.05).MP joint active range of motion increased from (21.7 ± 7.6)° preoperatively to (25.6 ± 9.3) ° at last follow-up (P＞0.05).The mean DASH score decreased from 46.3 ± 9.6 to 30.9 ± 11.6.The improvement was statistically significant (P ＜ 0.05).Implant dislocation was seen in one PIP joint in the middle finger and one MP joint in the thumb.No other complications such as implant rupture,peri-implant fracture or infections were noted.Conclusion The anatomical resurfacing artificial joint replacement is effective in treating joint stiffness,joint deformity and joint pain.The short-term results are satisfactory.Surgical approach and management of surrounding scarring tissues are subject to further investigation.