摘要
目的研究改良支具固定治疗伤后1个月以上陈旧腱性锤状指的临床效果。方法自2007年11月至2010年1月，对26例陈旧腱性锤状指患者采用改良支具固定。从受伤到接受固定时间为4～14周，平均7周。我们对传统固定支具进行改良，由近指间关节屈曲、远指间关节过伸位固定，改为近指间关节伸直、远指间关节轻度过伸，以增加固定的牢固性。严格固定6周后，去除外固定，开始功能练习，并用夜间支具继续固定4周。结果26例中，4例失访，22例获得随访，时间为2—6个月，平均3个月。接受治疗的手指均较治疗前有明显的改善。远指间关节伸直角度治疗前平均为－38°（－15°－－70°），治疗后为－20°（0°－－100°）。按照Patel评定法评定：优19例，良3例。有3例在固定过程中，由于固定粘带压迫，出现远指间关节一过性疼痛、肿胀；调整支具固定粘带后，症状缓解，能够继续固定。1例去除固定1周后出现15°的屈曲畸形，重新固定4周，获得完全正常的外观和功能。所有患者对治疗结果表示满意。结论即使是伤后长达3个月的陈旧性锤状指，采用支具固定这种简单、廉价而并发症少的治疗方法，仍然可以取得满意的结果。对于选择恰当的陈旧性锤状指患者，保守治疗仍然是治疗的首选方法。
Objective To evaluate the clinical results of modified thermoplastic splint for treatment of chronic tendinous mallet finger deformity that were 4 weeks or more old. Methods From November 2007 to January 2010, Twenty-six patients with chronic tendinous mallet deformities were treated with closed extension thermoplastic splint. The duration of the deformity before presentation ranged from 4 to 14 weeks, with an average duration of 7 weeks. We modified the current popular mallet splinting technique that immobilizes the DIP joint in extension and PIP joint in flexion to immobilizing the PIP joint in full extension and DIP joint in slight hyperextension. After 6 weeks continuous splinting, only night splinting was continued for an additional period of 4 weeks. The splint was removed and active mobilization of the finger was encouraged. Results Of the 26 patients, 22 could be reexamined and 4 were not available for follow-up. The average follow-up period was 3 months （range, 2 to 6 months）. The average pretreatment extension lag of the DIP joint was - 38°（range, - 15° to -70°）, and the average post-treatment extension lag was - 2°（ range, 0°to - 10°）. Based on Patel＇ s criteria, we had 19 patients with excellent results, and 3 with good results. Three patients developed pain and edema on the dorsum of the DIP joint from a dorsal nylon self-fastening strap. The symptoms were gone after the splints were adjusted. In 1 patient, the deformity recttrred in the first week after splinting was discontinued, and he had excellent results after resplinting for an additional period of 4 weeks. Satisfaction was expressed by all patieras. Conclusion Splinting is a predictable, safe, and simple method of treatment for chronic mallet finget that were even 3 months old. This low-morbidity, low-cost treatment should be the method of choice for patients that fulfill the outlined selection criteria.
出处
《中华手外科杂志》
CSCD
北大核心
2010年第6期328-331,共4页
Chinese Journal of Hand Surgery
关键词
腱损伤
治疗结果
锤状指
支具
Tendon injuries
Treatment outcome
Mallet finger
Splint
