母指CM関節不安定性に対する靭帯再建術の経験 [in Japanese] Ligament Reconstruction by Extensor Carpi Radialis Longus Tendon for Instability of Thumb CM Joint [in Japanese]
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母指CM関節不安定性による障害に対して長橈側手根伸筋腱（以下ECRL腱）を用いてIntermetacarpal lig.（以下IML）再建術を施行したので報告する．対象は靭帯再建術を施行した7例7手（母指CM関節症5例5手，外傷性不安定症2例2手）．性別は男性2例，女性5例，年齢は15～67歳，経過観察期間は6カ月～6年3カ月であった．Eaton分類はstage Iが4手，stage IIが3手であった．手術は琉球大法に準じて停止部を茎とするECRL半切腱を用いてIMLを再建した．手術成績（Eatonの評価），母指CM関節可動域，ピンチ力，握力，X線学的評価を検討した．手術成績はexcellent 5例，good 1例，failure 1例であった．Eaton分類でstageが進行した例は認めなかった．関節症変化が軽度の母指CM関節症と外傷性不安定症に対して本法は有効と考えられた．
Seven consecutive ligament reconstructions by extensor carpi radialis longus tendon for the instability of the thumb CM joint were reviewed in seven patients. They consisted of two males and five females, and their age ranged from 15 to 67 years. Postoperative follow-up periods ranged from six months to six yeas three months (average 2.5 years). According to Eaton's radiographic classification, there were four cases in stage I and three in stage II.<BR>The procedure was performed in accordance with University of Ryukyu's method. The half slip of ECRL tendon is passed through the bony tunnel made at the base of the first and second metacarpal, then it was sutured to itself under sufficient tension.<BR>Each case was evaluated by Eaton's clinical criteria, thumb CM joint range of motion, pinch power, grip power, and radiographic estimation.<BR>Overall results were excellent in five cases, good in one, and failed in one. The failed case was re-injured by traffic accident postoperatively. Except for this case, all cases achieved good results in terms of relief of pain. There were no significant differences with regard to thumb CM joint range of motion, pinch power, and grip power pre-and post-operatively. The operative radiographic stage did not progress in all cases, although one had minimum laxity.<BR>Ligament reconstruction by ECRL tendon may be a useful surgical procedure for unstable thumb CM joint.
- Orthopedics & Traumatology
Orthopedics & Traumatology 55(3), 358-362, 2006-09-25
West-Japanese Society of Orthopedics & Traumatology