Kardestuncer Tarik, Bae Donald S, Waters Peter M
Norwich Orthopaedic Group, North Franklin, CT, USA.
J Pediatr Orthop. 2008 Jan-Feb;28(1):81-5. doi: 10.1097/BPO.0b0131815ff31e.
The treatment of soft-tissue mallet fingers in children can be challenging because of delays in diagnosis and noncompliance with extension splinting or casting. The purpose of this investigation was to assess the results of tenodermodesis for the treatment of chronic soft-tissue mallet fingers in children.
A retrospective analysis of 10 patients younger than 18 years was performed. All had extensor lag greater than 45 degrees, absent active distal interphalangeal joint (DIPJ) extension, and full passive DIPJ motion. All patients had failed trails of nonoperative treatment. Tenodermodesis was performed using established techniques with 4 to 6 weeks of postoperative DIPJ immobilization. Patients were evaluated for active and passive DIPJ motion, deformity, pain, limitations in activities of daily living, and the need for additional treatment. Average age at the time of surgery was 7.4 years (range, 1.4-17.8 years).
At average 6.5-year follow-up (range, 1-12.8 years), all patients demonstrated restoration of active DIPJ extension and improvements in extensor lag. Two patients (20%) achieved full active DIPJ extension, whereas 8 patients (80%) had persistent extensor lag of 20 degrees or less. Seven patients (70%) maintained full active DIPJ flexion. Eight (80%) of the 10 patients reported full return to activities with no limitations. No patients required additional surgical treatment for their mallet fingers.
Tenodermodesis is a safe and effective technique for the treatment of severe chronic soft-tissue mallet finger deformities in children. Although patients and families should be advised of mild persistent extensor lag and limitations in DIPJ motion, active DIPJ extension and improved clinical appearance can be achieved with this procedure.
由于诊断延迟以及患儿不配合伸直位夹板固定或石膏固定，儿童软组织锤状指的治疗颇具挑战性。本研究旨在评估腱固定术治疗儿童慢性软组织锤状指的效果。
对10例18岁以下患儿进行回顾性分析。所有患儿均存在伸肌滞后大于45度、远侧指间关节（DIPJ）主动伸直功能缺失且DIPJ被动活动正常。所有患儿非手术治疗均失败。采用既定技术行腱固定术，术后DIPJ固定4至6周。评估患儿DIPJ的主动和被动活动、畸形、疼痛、日常生活活动受限情况以及是否需要进一步治疗。手术时的平均年龄为7.4岁（范围1.4 - 17.8岁）。
平均随访6.5年（范围1 - 12.8年），所有患儿DIPJ主动伸直功能均得以恢复，伸肌滞后情况改善。2例患儿（20%）DIPJ完全主动伸直，8例患儿（80%）伸肌滞后持续小于或等于20度。7例患儿（70%）DIPJ主动屈曲功能完全保留。10例患儿中有8例（80%）报告可完全恢复活动且无限制。无一例患儿因锤状指需要进一步手术治疗。
腱固定术是治疗儿童严重慢性软组织锤状指畸形的一种安全有效的技术。尽管应告知患儿及其家属可能存在轻度持续性伸肌滞后以及DIPJ活动受限，但通过该手术可实现DIPJ主动伸直并改善临床外观。
