拇指掌指关节掌侧脱位4例病例报告和文献回顾

发布时间：2018-05-30 07:46

本文选题：拇指掌指关节 + 损伤机制　；参考：《吉林大学》2015年硕士论文

【摘要】：目的：拇指掌指关节掌侧脱位是一种少见的损伤，其损伤机制、治疗方法及预后均不十分明确。我们通过对我院4例掌指关节掌侧脱位病例的研究，并查阅相关文献上所报道的26例拇指掌指关节掌侧脱位的病例，对其进行描述及分析，以期发现其损伤机制、诊断、治疗、预后的一般规律，进而指导以后的临床工作，促进患者愈后功能恢复，，减少并发症。材料和方法：收集我科室既往的4例拇指掌指关节掌侧脱位病例，其中手术切开复位3例，闭合复位1例。查阅既往文献所报道的26例拇指掌指关节掌侧脱位病例，其中手术切开复位19例，闭合复位7例。详细查阅其病史、查体、治疗方案、预后等，综合分析上述病例一般特点。解剖学研究：通过尸体解剖，从解剖基础上探讨拇指掌指关节稳定结构如侧副韧带、掌板等在拇指掌指关节掌侧脱位中的作用。结合病例研究，进一步研究探讨损伤可能机制及对愈后的影响。结果和结论：拇指掌指关节的损伤机制主要为：外力作用在拇指近节指骨时引起第一掌指关节的过度屈曲，并多合并旋转暴力，导致掌板、关节囊、侧副韧带及伸肌腱损伤等稳定结构的损伤，最终引起掌指关节向掌侧脱位。侧副韧带的损伤是拇指掌指关节掌侧脱位的首要因素。认真进行体格检查、辅助检查，选择合适的病例进行早期手法复位，结合正确的功能锻炼，术后功能与手术复位治疗相比满意度较高。一旦无法复位或者复位后再发生脱位应及时给予手术治疗，术中注意保证关节稳定性的前提下，调整掌指关节周围软组织张力，尽量采用抽出式缝合修复侧副韧带以减少关节周围异物，可以获得较好的疗效。
[Abstract]:Objective:
The palmar dislocation of the metacarpophalangeal joint of the thumb is a rare injury, and its damage mechanism, treatment and prognosis are not very clear. Through the study of 4 cases of palmar dislocation of the metacarpophalangeal joint in our hospital and 26 cases of the palmar dislocation of the thumb metacarpophalangeal joint reported in the related literature, it is described and analyzed in order to find out. The general rule of injury mechanism, diagnosis, treatment and prognosis will guide clinical work in the future, promote functional recovery and reduce complications.
Materials and methods:
A total of 4 cases of palmar dislocation of the thumb metacarpophalangeal joint were collected in our department, including 3 cases of open reduction and 1 closed reduction. 26 cases of palmar dislocation of thumb metacarpophalangeal joint reported in the previous literature, including 19 cases of open reduction and 7 closed reduction, were reviewed in detail, and the comprehensive analysis was made on the comprehensive analysis. The general characteristics of the cases are described.
Anatomical study: the role of the stable structure of the thumb metacarpophalangeal joint, such as the lateral collateral ligament and the palmar plate in the palmar dislocation of the thumb metacarpophalangeal joint, was studied on the basis of autopsy.
Results and conclusion: the main mechanism of the injury of the metacarpophalangeal joint is: the external force causes the excessive flexion of the first metacarpophalangeal joint when the thumb is near the phalanges, and more combined rotating violence, resulting in the injury of the palmar plate, the joint capsule, the lateral collateral ligament and the extensor tendon injury, which eventually causes the palmar joint to the palmar dislocation. Injury is the primary factor of palmar dislocation of thumb metacarpophalangeal joint.
Careful physical examination, auxiliary examination, selection of appropriate cases for early manual reduction, combined with correct functional exercise, the postoperative function is more satisfactory compared with surgical reduction. The soft tissue tension around the knuckle and the use of extractable suture to repair the lateral collateral ligament to reduce the foreign body around the joint can achieve better results.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【共引文献】