近侧指间关节掌板损伤应用解剖学研究及临床治疗

目的：探讨近侧指间关节（PIP）掌板损伤对近侧指间关节稳定性及晚期关节屈曲挛缩的影响，同时评价临床治疗效果。方法：（1）新鲜尸体20个手指，观察PIP关节掌板及其周围韧带的解剖学特点，并进行掌板损伤模拟实验。（2）手术治疗PIP掌板损伤12例，其中新鲜损伤7例，陈旧损伤5例。结果：（1）切断掌板远端连接韧带后，掌板向近端回缩，其断端合拢时PIP关节屈曲度为35°～50°。掌板远端切断后背伸度为（23．4±6．6）°，掌板和单侧侧副韧带同时切断后背伸度为（51．3±7．8）°，而侧搬度为（41．8±5．5）°。（2）12例患者术后随访3～13个月。新鲜病例7例，PIP关节主动背伸为0—15°，平均8°；屈曲基本正常。陈旧病例关节松解术3例5次，关节挛缩均复发；掌板松解、指浅屈肌腱切断后长期使用弹性支具1例，症状明显改善；掌板松解和2区伸肌腱切断1例，基本恢复正常。结论：掌板损伤后向近侧退缩粘连和瘢痕挛缩是晚期关节屈曲挛缩的主要原因；掌板损伤以早期修复为佳，晚期关节松解效果差，以单纯掌板松解为宜。

The Injury of Volar Plate in Proximal Interphalangeal(PIP) Joint:Anatomic and Clinical Study

bjective ：To discuss the influence of velar plate injury on joint stability and the reasons for advanced-stage joint flexed contracture by means of studying the anatomic features of volar plate（VP） and surrounding ligaments of PIP. Methods ： （ 1 ） 20 fingers of fresh cadaver specimens were used to observe the anatomic features of volar plate and surrounding ligaments of PIP, and to undertake model experiment of injury. （2） 12 cases （ 14 times） of volar plate injury were operated. Results： （ 1 ）Volar plate proximately retracts while the distal ligament was cut off, and the flextion degree was 35° -50° when the ends rejointed. Extention degree was （51.3 ±7.8 ）°while distal end of VP and collateral ligament were cut off, while lateral-movement degree was （41.8±5.5）°. （2） Twelve patients were followed up for 3 -13 months after operation. At the latest follow- up, the initiative extention movement of PIP was 0 - 15° in 7 patients with fresh injure, 8° in average. Arthrolysis was applied in chronic cases （3 cases 5 times）. After operation, contraeture of joints occurred in all cases; Palma solution, musculus flexor digitorum sublimis tenotomy and elasticity orthosis were applied in 1 case, symptoms were improved obviously. Palma solution and extensor tendon cut-off in 1 case, it recovered to normal. Conclusions：The main reasons for advanced joint flexion contraction were volar plate proximal retraction, adhesion and cicatricial contraction. Earlier repair was the best choice for injured palma, while for chronic cases, arthrolysis had poor result and palma solution was the better choice.