摘要目的 对比拇指腕掌关节炎患者行关节融合术与关节成形术的手术效果,比较两种术式的优缺点.方法 自 2012年 2月至 2017年 9月,分别对 39例 Ⅱ 、Ⅲ期的拇指腕掌关节炎患者行手术治疗,其中 22例患者行大多角骨-第一掌骨基底融合术,17例患者行大多角骨切除+韧带重建+肌腱球填塞的关节成形术(LRTI),对两组手术效果进行评价,客观评价包括术后握力、捏力、外展角度(掌侧、桡侧)、拇指对掌Kapandji评分,主观评价包括视觉模拟疼痛评分(VAS)及臂肩手功能障碍评分(DASH,比较两种术式的数据,观察其差异性.结果 关节融合组与关节成形组术后数据相比较,捏力、外展角度(掌侧、桡侧)、拇指对掌Kapandji评分差异明显,握力、VAS 、DASH评分无明显差异.结论 对于进展期拇指腕掌关节炎患者行腕掌关节融合术或成形术,两种术式均能明显减轻关节疼痛并改善握力,融合术在拇指捏力方面改善更好,而关节成形术在拇指活动度方面改善更好,患者对两种手术方式效果均自觉满意.

abstractsObjective To compare the effect of arthrodesis and arthroplasty in patients with thumb carpometacarpal osteoarthritis,and to compare the advantages and disadvantages of the two methods.Methods From February 2012 to September 2017,39 patients with phases Ⅱ and Ⅲ thumb carpometacarpal osteoarthritis underwent surgical treatment.22 cases were performed with trapeziometacarpal arthrodesis and 17 cases were performed with trapezial excision arthroplasty with ligament reconstruction and tendon interposition(LRTI).Postoperatively,objective and subjective evaluation were performed on the two groups,respectively.The objective evaluation included grip strength,pinch strength,thumb abduction degree(palmer and radial),Kapandji opposition score.The subjective evaluation included visual analogue scale(VAS),Disabilities of the Arm,Shoulder and Hand(DASH)score.The data of the two methods were compared and their differences were observed.Results In the comparison between arthrodesis and arthroplasty group,the differences of pinch strength,thumb abduction degree(palmer and radial),Kapandji opposition score were obvious,but there was no significant difference in grip strength,VAS and DASH score.Conclusion For patients with progressive thumb carpometacarpal osteoarthritis,carpometacarpal arthroplasty or arthroplasty can significantly relieve joint pain and improve grip strength.Arthrodesis can improve thumb pinch strength better,while arthroplasty can improve thumb mobility better.The patients are consciously satisfied with the effects of the two surgical methods.