Catalano Louis W, Gupta Salil, Ragland Raymond, Glickel Steven Z, Johnson Caryl, Barron O Alton
Department of Orthopaedic Surgery, St. Luke's-Roosevelt Hospital Hand Service, New York, NY, USA.
J Hand Surg Am. 2006 Feb;31(2):242-5. doi: 10.1016/j.jhsa.2005.10.009.
Acute sagittal band injuries at the metacarpophalangeal (MCP) joint resulting in subluxation or dislocation of the extensor tendons may cause pain and swelling at the MCP joint and limit active extension of the MCP joint. These injuries often are treated with surgical repair or reconstruction. This article outlines a nonsurgical treatment protocol that uses a customized splint for acute, nonrheumatoid extensor tendon dislocations caused by injury to the sagittal bands.
We retrospectively reviewed 10 patients with 11 acute sagittal band injuries who were treated with a splint of thermally molded plastic that differentially holds the injured MCP joint in 25 degrees to 35 degrees of hyperextension relative to the adjacent MCP joints. All the sagittal band ruptures resulted in complete dislocation of the extensor digitorum communis (EDC) tendon-Rayan and Murray type III injuries. Active proximal interphalangeal and distal interphalangeal motion was begun immediately at the time of initial splinting. The average follow-up period was 14 months.
At the time of final evaluation all patients had full range of motion in flexion and extension. Eight patients had no pain and 3 had moderate pain. Four patients (5 digits) had no extensor tendon subluxations and 3 had barely discernable subluxations. Three patients had moderate subluxation of the EDC tendon and their treatments were considered failures. One of these patients had subsequent sagittal band reconstruction.
Our results show acute sagittal band injuries in nonrheumatoid patients resulting in dislocation of the EDC tendon can be managed nonsurgically in many patients with a customized splint called the sagittal band bridge.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.
掌指（MCP）关节处的急性矢状带损伤导致伸肌腱半脱位或脱位，可能会引起MCP关节疼痛和肿胀，并限制MCP关节的主动伸展。这些损伤通常采用手术修复或重建治疗。本文概述了一种非手术治疗方案，该方案使用定制夹板治疗由矢状带损伤引起的急性、非类风湿性伸肌腱脱位。
我们回顾性研究了10例患者的11处急性矢状带损伤，这些患者使用热塑塑料夹板治疗，该夹板相对于相邻MCP关节将受伤的MCP关节保持在25度至35度的过伸位。所有矢状带断裂均导致指总伸肌（EDC）肌腱完全脱位——Rayan和Murray III型损伤。在初次使用夹板时立即开始主动近端指间关节和远端指间关节活动。平均随访期为14个月。
在最终评估时，所有患者的屈伸活动范围均正常。8例患者无疼痛，3例有中度疼痛。4例患者（5指）无伸肌腱半脱位，3例有难以察觉的半脱位。3例患者的EDC肌腱有中度半脱位，其治疗被认为失败。其中1例患者随后进行了矢状带重建。
我们的结果表明，非类风湿性患者因EDC肌腱脱位导致的急性矢状带损伤，在许多患者中可以使用一种名为矢状带桥的定制夹板进行非手术治疗。
研究类型/证据水平：治疗性研究，IV级。
