动态肌腱固定术治疗类风湿关节炎所致尺侧漂移伴伸肌腱半脱位

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-08-14 DOI:10.1016/j.jhsg.2025.100808

Ryo Oda MD, PhD , Naoki Okubo MD, PhD , Shogo Toyama MD, PhD , Shinji Tsuchida MD, PhD , Kenji Takahashi MD, PhD

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引用次数: 0

摘要

目的：研究类风湿性关节炎引起的尺侧漂移（UD）伴伸肌腱半脱位的原始功能重建手术的疗效。方法2018年至2022年，对10例（31指）类风湿性关节炎UD患者进行重建，随访至少2年。平均年龄57岁，平均随访时间4.5年。采用Fearnley分级法对17例1期病例和14例2期病例进行尺侧漂移评估。在掌骨头上方形成了半滑移肌腱。将锚钉打入掌骨桡侧掌指骨（MCP）关节旋转中心，缝合固定半滑移肌腱。如果观察到MCP关节屈曲受限，则对伸肌腱进行阶梯切割，并通过交错缝线将半滑移肌腱固定在阶梯切割的远端伸肌腱上。我们调查了病人的背景和活动范围。手臂、肩膀和手的残疾问卷和密歇根手部结果问卷的患者报告的结果测量被评分为功能结果。结果术后平均54个月，MCP关节的平均伸展度由术前的- 12°（范围：- 80°至28°）改善到最后随访时的1.5°（范围：- 40°至20°）(P <；.05)，而平均屈曲度无显著变化。手术后MCP关节的平均活动弧度明显增加至95°（范围：60°-120°），而术前为82°（范围：34°-118°）(P <；. 05)。手臂、肩膀和手的残疾问卷和密歇根手结局问卷得分显著提高。没有复发的UD，如降低费恩利期，被记录。结论：我们使用动态肌腱固定术作为类风湿性关节炎引起的手指伸肌腱半脱位的UD的功能重建，并特别关注通过软组织重建来保护关节，结果良好，无复发。研究类型/证据水平治疗性IV。

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Dynamic Tenodesis Technique for Ulnar Drift With Extensor Tendon Subluxation due to Rheumatoid Arthritis

Purpose

We investigated the outcomes of an original functional reconstruction procedure for ulnar drift (UD) with extensor tendon subluxation due to rheumatoid arthritis.

Methods

From 2018 to 2022, reconstruction was performed in 10 patients (31 fingers), with UD due to rheumatoid arthritis and a minimum of 2-year follow-up. The mean age was 57 years, and the mean follow-up period was 4.5 years. Ulnar drift was assessed using the Fearnley classification and included 17 stage 1 cases and 14 stage 2 fingers. A half-slip tendon was created just above the metacarpal head. An anchor was driven into the center of rotation of the metacarpophalangeal (MCP) joint on the radial side of the metacarpal bone, and the half-slip tendon was sutured and fixed. If limitations were observed in the flexion of the MCP joint, the extensor tendon was step-cut, and the half-slip tendon was fixed via an interlacing suture to the step-cut distal extensor tendon. We investigated the patient’s background and range of motion. The Disabilities of the Arm, Shoulder, and Hand questionnaire and the Michigan Hand Outcomes Questionnaire of patient-reported outcome measures were scored as functional outcomes.

Results

At a mean of 54 months after the operation, the average extension in the MCP joint improved from −12° (range: −80° to 28°) before surgery to 1.5° (range: −40° to 20°) at the final follow-up (P < .05), whereas the average flexion had no remarkable change. The average active arc of motion of the operated MCP joint was significantly increased to 95° (range: 60°–120°) compared with 82° (range: 34°–118°) before surgery (P < .05). The Disabilities of the Arm, Shoulder, and Hand questionnaire and the Michigan Hand Outcomes Questionnaire scores improved significantly. No recurrence of UD, such as a decreased Fearnley stage, was documented.

Conclusions

We present good results with no recurrence using a dynamic tenodesis technique as a functional reconstruction for UD with finger extensor tendon subluxation caused by rheumatoid arthritis, with a particular focus on joint preservation via soft tissue reconstruction.