先天性手部关节挛缩症的治疗

目的 探讨先天性多发性手部关节挛缩症手术方法的选择.方法 对8例(23指)先天性手部关节挛缩症的患儿,分别采用关节囊掌板松解、指浅屈肌腱止点切断、深浅肌腱交替术、皮片移植术等方法,术中以挛缩的关节能被动伸直为标准,采用克氏针内固定和术后石膏外固定相结合的方法进行治疗.结果 术后23指伤口均I期愈合.随访时间为12～25个月,关节功能及手指外形良好,除1例(4指)出现肌腱轻度粘连外,7例中14指(累及掌指关节1指,近指间关节13指)主、被动活动达到正常.其余手指背伸损害值V伸=5°～10°.结论 手部先天性多发性关节挛缩症根据组织的挛缩程度,通过上述方法可获得良好的治疗效果.

Treatment of congenital joint contracture of the hand

Objective To discuss the surgical options for treatment of congenital joint contracture of the hand. Methods Eight cases (23 fingers) of congenital joint contractures of the hand were treated. The contractured joints were released to full extension at passive motion intraoperatively by releasing the joint capsule and volar plate, dividing insertion of the flexor digitorum superficialis, tendon lengthening by alternating the superficial and deep flexor tendons, and skin grafting. The extended joints were fixed by Kirschner wire and immobilized by plaster postoperatively. Results Primary wound healing was achieved in all 23 cases. Follow-up period was 12 to 25 months. Joint function and finger appearance were good. Except for one patient (4 fingers) who had mild tendon adhesion, 7 cases 14 fingers (metacarpophalangeal joint in 1 finger and proximal interphalangeal joint in 13 fingers) achieved normal active and passive range of motion. The rest had extension lag = 5° to 10°. Conclusion Choosing joint release procedures based on the severity of joint contractures can lead to good function.