陳旧性母指MP関節橈側側副靱帯損傷に対する観血的治療の経験

Surgical Treatment of Chronic Injuries of the Radial Collateral Ligament of the Metacarpophalangeal Joint of the Thumb

　観血的治療を行った陳旧性母指MP関節橈側側副靱帯損傷の臨床像，治療成績について若干の考察を加え報告する．受傷から1カ月以上経過して当院を受診し，加療を行った4例4指を対象とした．4例中2例では著明な不安定性はなく，むしろ痛み，しびれ，Tinel徴候様の放散痛をMP関節背橈側に認めた．それらの症例では，短母指外転筋のexpansion hoodまで及ぶ瘢痕組織を認め，同部で橈骨神経浅枝の母指橈側枝の癒着を認めた．全例にアンカースーチャーを行い，症状は軽快し，原職，スポーツへ復帰した．陳旧性母指MP関節橈側側副靱帯損傷のなかには不安定性よりも痛みを主とする症例があり，そのような例では橈骨神経浅枝の関与も考えられた．

　We report four cases of injury of the radial collateral ligament of the metacarpophalangeal (MP) joint of the thumb that were treated surgically.　There were 3 males and 1 female, and their ages ranged from 19 to 59 years old (mean 35.5 years).　Two patients were found to have gross laxity in manual stress tests or more than 15° instability compared with the uninjured joint on stress radiographs, and resting radiographs revealed ulnar and/or volar subluxations.　The other 2 patients complained of radiating pain, and a Tinel-like sign was elicited at the MP joints.　The intervals between the injury and treatment ranged from 2.5 months to 14 months.　Anchor sutures were used in all 4 patients.　Adhesion of the sensory branch of the radial nerves was observed at surgery in both patients with radiating pain.　During the follow-up period (mean：2.5 months), all patients reported relief of their pain and had returned to their previous work or sports activities.