Calfee R P, Kiefhaber T R, Sommerkamp T G, Stern P J
Department of Orthopedic Surgery, Division of Hand Surgery, Washington University School of Medicine, St. Louis, MO, USA.
J Hand Surg Am. 2009 Sep;34(7):1232-41. doi: 10.1016/j.jhsa.2009.04.027.
Hemi-hamate resurfacing arthroplasty is a treatment alternative for the management of severe acute and chronic dorsal proximal interphalangeal (PIP) fracture-dislocations. This study was designed to determine whether this procedure would successfully restore function after such injuries.
Hemi-hamate reconstructions were performed on 33 patients (mean age, 34 years) who presented to 1 hand surgery practice with dorsal PIP fracture-dislocations. Eligible patients experienced unstable dislocations with comminuted metaphyseal fractures involving at least 50% of the volar middle phalangeal surface that was not amenable to open reduction and internal fixation. We evaluated 22 patients with 14 acute (<6 weeks) and 8 chronic (mean, 30 weeks) injuries at a mean of 4.5 years (range, 1-7 years). Functional outcomes were assessed by objective and subjective measures: joint alignment/motion/stability, grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and visual analog scales (VAS) of pain and function.
After hemi-hamate reconstruction, active PIP motion averaged 70 degrees (acute 71 degrees , chronic 69 degrees ) with a mean flexion contracture of 19 degrees (range, 0 degrees to 80 degrees ). Active distal interphalangeal motion averaged 54 degrees (acute 56 degrees , chronic 51 degrees ). The mean VAS score for digit pain was 1.4 (acute 0.7, chronic 2.5). The mean DASH score of 5 (acute 2, chronic 9) and VAS functional score of 1.9 (acute 1.4, chronic 2.6) indicated little functional impairment (acute 2, chronic 9). Grip strength averaged 95% of the opposite hand. Mean coronal plane angulation at the PIP joint was 3 degrees . Ten patients reported aching with cold temperatures. One dissatisfied patient underwent revision surgery. Chronic reconstructions were associated with increased VAS pain ratings (p = .02) and higher DASH scores (p = .06).
Hemi-hamate reconstruction represents a valuable surgical procedure to address severe PIP joint fracture-dislocations. Reconstruction of chronic injuries by this method restores PIP function, albeit with more modest outcome performance.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
半钩骨表面置换关节成形术是治疗严重急性和慢性近节指间关节（PIP）背侧骨折脱位的一种替代治疗方法。本研究旨在确定该手术能否在此类损伤后成功恢复功能。
对33例（平均年龄34岁）因PIP背侧骨折脱位就诊于一家手外科诊所的患者进行半钩骨重建。符合条件的患者存在不稳定脱位，伴有干骺端粉碎性骨折，累及掌侧中节指骨表面至少50%，无法进行切开复位内固定。我们评估了22例患者，其中14例为急性损伤（<6周），8例为慢性损伤（平均30周），平均随访4.5年（范围1 - 7年）。通过客观和主观指标评估功能结果：关节对线/活动度/稳定性、握力、手臂、肩部和手部功能障碍（DASH）评分以及疼痛和功能的视觉模拟量表（VAS）。
半钩骨重建后，PIP主动活动平均为70度（急性损伤71度，慢性损伤69度），平均屈曲挛缩为19度（范围0度至80度）。远节指间关节主动活动平均为54度（急性损伤56度，慢性损伤51度）。手指疼痛的平均VAS评分为1.4（急性损伤0.7，慢性损伤2.5）。平均DASH评分为5分（急性损伤2分，慢性损伤9分），VAS功能评分为1.9分（急性损伤1.4分，慢性损伤2.6分），表明功能损害较小（急性损伤2分，慢性损伤9分）。握力平均为对侧手的95%。PIP关节冠状面平均成角为3度。10例患者报告遇冷时疼痛。1例不满意患者接受了翻修手术。慢性重建与VAS疼痛评分增加（p = 0.02）和DASH评分升高（p = 0.06）相关。
半钩骨重建是治疗严重PIP关节骨折脱位的一种有价值的手术方法。用这种方法重建慢性损伤可恢复PIP功能，尽管结果表现较为一般。
研究类型/证据水平：治疗性IV级。
