Anandacoomarasamy Ananthila, Englert Helen, Manolios Nicholas, Kirkham Stuart
Department of Rheumatology, Royal North Shore Hospital, St. Leonards, North South Wales, Australia.
J Hand Surg Am. 2007 Sep;32(7):1107-12. doi: 10.1016/j.jhsa.2007.06.011.
Systemic scleroderma can cause significant hand deformity and functional impairment. Surgery is often avoided due to the perceived risks of wound healing. The most common surgical procedures have been digital sympathectomy, arthrodesis or arthroplasty of the proximal interphalangeal (PIP) or both, and metacarpophalangeal (MCP) joints. We describe herein successful soft tissue hand surgery in 2 patients for treatment of scleroderma claw deformities without the use of arthrodesis or arthroplasty. At the MCP joint, the tight capsules were excised, and the collateral ligaments and volar plates were released. At the PIP joints, the volar plates were released and the tight palmar skin was released, resulting in marked improvement of joint position. Intensive hand therapy was used to maximize function. In these 2 patients with claw deformity, we found that tight volar skin was the main contributor to flexion contracture at the PIP level. In contrast, joint capsule contracture was the main contributor to hyperextension deformity at the MCP level.
系统性硬化症可导致严重的手部畸形和功能障碍。由于存在伤口愈合风险，手术通常不被采用。最常见的外科手术包括手指交感神经切除术、近端指间关节（PIP）或两者以及掌指关节（MCP）的关节融合术或关节成形术。我们在此描述了2例成功的手部软组织手术，用于治疗硬皮病爪形畸形，且未使用关节融合术或关节成形术。在MCP关节处，切除紧张的关节囊，松解侧副韧带和掌板。在PIP关节处，松解掌板并松解紧张的手掌皮肤，从而使关节位置明显改善。采用强化手部治疗以最大限度地恢复功能。在这2例爪形畸形患者中，我们发现紧张的手掌皮肤是PIP水平屈曲挛缩的主要原因。相比之下，关节囊挛缩是MCP水平过伸畸形的主要原因。
