Ligament reconstruction of the first carpometacarpal joint

Applicable to the dorsal subluxation of the first carpometacarpal joint. Tendon ruptures and defects are common diseases, mostly caused by injuries or lesions. In order to restore the function of the limbs, fingers and toes, the broken or defective tendons must be repaired in time. However, almost all repaired tendons form different degrees of adhesion and joint activity disorder with surrounding tissues, which is closely related to local pathological conditions, surgical technique, suture material, and correct postoperative treatment, and must be taken seriously. This article describes the commonly used tendon suture method and its technique. Treatment of diseases: joint dislocation Indication The recurrent dislocation of the carpometacarpal joint caused by trauma is the main one, and those with difficulty in repairing the acute ligament can also be used in the first phase. Should strive for the joint dislocation caused by rheumatoid or joint degenerative changes before the occurrence of traumatic arthritis, clinical application has no application experience, the changes of the joint itself will inevitably affect the surgical efficacy, should be balanced to consider various factors. Contraindications 1. The infection after the local injury has not been eliminated. 2. Injury refers to the passive flexion and extension of each joint. Preoperative preparation 1. Edema and inflammation of the limbs and wards, even if mild, should be actively treated, so that it completely disappears after 2 to 3 months of surgery. 2. Local large and hard scars should be removed first and the flaps should be repaired to ensure a good blood supply and a soft loose tissue bed around the tendons. 3. Before the tendon is sutured, the joint stiffness of the dominant tendon should be treated first, and the physical therapy and active and passive exercise should be given to restore the greater activity, so that the effect of the tendon suture can be operated and received. 4. The suture material should be selected from the varieties with small reaction, large pulling force and smooth surface. Generally, soft stainless steel wire with a diameter of 0.25 to 0.30 mm is preferred, and is mostly used for drawing steel wire stitching. Tendons with small or small diameters can be sutured with Nilon monofilament. Filament thread suture has a certain degree of tissue reaction, mostly used for Bunnell burial suture, but the silk thread must be able to withstand 1 to 1.5 kg of tensile force. 5. Prepare a slender straight round needle for suturing the tendon. Surgical procedure Along the lateral edge of the big fish muscle tendon, a longitudinal incision is made on the side of the first metacarpal near 1/2 ,, and the distal wrist is turned to the volar side of the tendon, and the wrist flexor tendon is stretched over the forearm. 3~4cm on the wrist. The large fish muscles were dissected, and the metacarpal bone, the first carpometacarpal joint, and the temporal flexor tendon were revealed. The forearm cut off the temporal side of the radial flexor tendon and dissociated distally, making it a purlin with a distal end attached to the base of the second metacarpal, about 6 cm long. On the dorsal side of the metacarpal basement (the ulnar side of the long abductor muscle), the diameter is 0.25~0.3cm. The tendon strip is introduced into the bone hole through the volar side and then passed out through the dorsal side. The deep tendon of the thumb is stretched back to the volar side of the first carpometacarpal joint, then tightened to reduce the dislocation joint, and then the needle is placed through the first metacarpal base to the majority of the horn. The two needles were sutured intermittently with a 3-0 silk thread, and the tendon strip was fixed to the periosteum around the bone hole and the abductor tendon of the thumb. The tendon strip is wrapped around the deep side of the ulnar side of the radial flexor tendon and then tightened and sewn together. Wash the wound, loosen the tourniquet, stop bleeding, and confirm the closure of the incision after no active bleeding. complication Suppurative infection, infected wounds have pain, redness, tenderness, purulent secretions, etc., body temperature can be increased and neutrophils can be increased. Closed wounds may also be associated with various infections, such as post-injury aspiration, airway endocrine retention, and atelectasis secondary lung infections. Tetanus or gas gangrene may also occur after the injury, and the consequences are quite serious.