Chao Jerome D, Sarwahi Vishal, Da Silva Yong Sing S, Rosenwasser Melvin P, Strauch Robert J
Department of Orthopaedic Surgery, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, 622 W. 168th Street, New York, NY 10032, USA.
J Hand Surg Am. 2004 Mar;29(2):216-9. doi: 10.1016/j.jhsa.2003.10.025.
Tenotomy of the central slip, described by Fowler, can clinically improve chronic distal interphalangeal joint (DIP) extensor lag secondary to mallet finger (terminal tendon disruption). The goal of this study is to evaluate the potential of central slip tenotomy to restore DIP joint extension.
A mallet deformity was reproduced in 15 fresh-frozen cadaver fingers after the extensor tendon insertion was sectioned over the DIP joint. A suture anchor inserted at the terminal insertion was then secured to the extensor tendon over the middle phalanx to reconstruct the extensor mechanism. A 500-g weight attached to the proximal extensor tendon applied extensor tension. Central slip tenotomy was then performed. DIP extensor lags before and after tenotomy were recorded.
After sectioning of the terminal tendon over the DIP joint the average amount of extensor tendon lag produced was 45 degrees. After central slip tenotomy was performed the average amount of extensor lag correction was 36 degrees (range, 30 degrees-46 degrees).
Several clinical studies have shown that central slip tenotomy is an effective treatment for chronic mallet finger but may not fully restore DIP joint extension. Our data suggest that patients with a pre-existing extensor lag of greater than 36 degrees may not achieve full extension from central slip tenotomy, although extensor lags of up to 46 degrees may be corrected.
福勒描述的中央束切断术，在临床上可改善槌状指（终末肌腱断裂）继发的慢性远侧指间关节（DIP）伸肌滞后。本研究的目的是评估中央束切断术恢复DIP关节伸展的潜力。
在15个新鲜冷冻尸体手指上复制槌状畸形，方法是在DIP关节上方切断伸肌腱止点。然后将插入终末止点的缝线锚固定于中节指骨上方的伸肌腱，以重建伸肌机制。在近端伸肌腱上连接一个500克的重物以施加伸肌张力。随后进行中央束切断术。记录切断术前和术后的DIP伸肌滞后情况。
在DIP关节上方切断终末肌腱后，产生的伸肌腱滞后平均量为45度。进行中央束切断术后，伸肌滞后的平均矫正量为36度（范围为30度至46度）。
多项临床研究表明，中央束切断术是治疗慢性槌状指的有效方法，但可能无法完全恢复DIP关节伸展。我们的数据表明，预先存在的伸肌滞后大于36度的患者可能无法通过中央束切断术实现完全伸展，尽管高达46度的伸肌滞后可能得到矫正。
