Nalebuff E A, Millender L H
Orthop Clin North Am. 1975 Jul;6(3):753-63.
The rheumatoid boutonniere deformity does not limit hand function significantly until it becomes severe. For this reason the surgical procedures used should not risk or sacrifice existing function. For the mild cases one can improve the digital balance by a simple extensor tenotomy combined with dynamic splinting. In more advanced stages with passive correction possible, the deformity can be improved by reconstruction of the extensor mechanism. With fixed deformities one can choose between proximal interphalangeal joint fusion and arthroplasty. The decision is influenced by several factors, including the digit involved and the status of adjacent joints. After a careful evaluation of the patient's capabilities and needs, it is possible to improve these deformities by the methods discussed.
类风湿性纽扣花样畸形在变得严重之前不会显著限制手部功能。因此，所采用的外科手术不应危及或牺牲现有的功能。对于轻度病例，可通过简单的伸肌肌腱切断术结合动力夹板来改善手指平衡。在更晚期且可能进行被动矫正的阶段，可通过重建伸肌机制来改善畸形。对于固定畸形，可在近端指间关节融合术和关节成形术之间进行选择。这一决定受多种因素影响，包括受累手指及相邻关节的状况。在仔细评估患者的能力和需求后，采用所讨论的方法有可能改善这些畸形。
