Borisch N, Siemon B, Heers G, Döbler A
DRK-Klinik, Abteilung für Handchirurgie, Plastische und Wiederherstellungschirurgie, Baden-Baden.
Handchir Mikrochir Plast Chir. 2010 Feb;42(1):65-70. doi: 10.1055/s-0030-1247591. Epub 2010 Mar 4.
The aim of this study was to assess the results of operative treatment for rheumatoid swan neck deformity using Littler's technique consisting in the reconstruction of the oblique retinacular ligament.
From 2004 to 2007 twenty rheumatoid patients with 30 PIP-joints affected by swan neck deformity underwent surgical correction. In all cases the tenodesis described by Littler was used. Modification of the operative procedure because of insufficiency of the Cleland ligament or the A2-pulley was in no case necessary. Twenty six PIP-joints in 17 patients could be examined after an average follow-up of 22 months. In two PIP-joints the deformity was contract and in 12 PIP-joints partially contract. In 10 joints a dorsal arthrolysis had to be performed and in one a lengthening of the central slip. All PIP-joints were transfixed in 30 degrees flexion. After 6 weeks the transfixing wire was removed and active PIP- joint mobilisation was allowed. Active extension was limited to 20 degrees of flexion until the end of the 12 (th) postoperative week. During this time an extension blocking splint was used. After the 12 (th) week free active and passive mobilisation of the PIP-joint was allowed. In a retrospective study pre- and postoperative range of motion, X-ray findings, pain and patient's content were examined.
Swan neck deformity was corrected in all cases. Preoperative hyperextension of 21 degrees on average was corrected to 24 degrees of flexion. Thereby the ROM of 48 degrees was shifted from the extension sector to a ROM of 51 degrees towards the flexion sector. Recurrence of the deformity or complications were not noted. Pain could be reduced except in one patient. Radiologic changes were classified Larsen grade 2.2 before and 2.3 after operation.
With the oblique retinacular ligament repair described by Littler reliable results can be achieved in rheumatoid swan neck deformity. It is indicated in contract and non-contract rheumatoid swan neck deformity when th PIP-joints are radiologically in a stage of less than Larsen grade 3. It corrects the deformity at the level of the PIP-joint as well as the DIP-joint.
本研究旨在评估采用利特勒技术（包括重建斜支持韧带）治疗类风湿性鹅颈畸形的手术效果。
2004年至2007年，20例患有30个受鹅颈畸形影响的近端指间关节（PIP关节）的类风湿患者接受了手术矫正。所有病例均采用利特勒描述的腱固定术。因克莱兰韧带或A2滑车功能不全而修改手术操作的情况在任何病例中均无必要。17例患者的26个PIP关节在平均随访22个月后接受了检查。2个PIP关节畸形为挛缩，12个PIP关节为部分挛缩。10个关节需要进行背侧关节松解术，1个关节需要延长中央束。所有PIP关节均固定于30度屈曲位。6周后取出固定钢丝，允许PIP关节进行主动活动。主动伸展限制在屈曲20度以内，直至术后第12周结束。在此期间使用伸展阻挡夹板。术后第12周后，允许PIP关节进行自由的主动和被动活动。在一项回顾性研究中，对术前和术后的活动范围、X线表现、疼痛情况及患者满意度进行了检查。
所有病例的鹅颈畸形均得到矫正。术前平均21度的过伸矫正为24度的屈曲。由此，48度的活动范围从伸展区转移至屈曲区51度的活动范围。未发现畸形复发或并发症。除1例患者外，疼痛均有所减轻。放射学改变术前为拉森2.2级，术后为2.3级。
采用利特勒描述的斜支持韧带修复术，可在类风湿性鹅颈畸形治疗中取得可靠效果。当PIP关节放射学表现处于拉森3级以下时，适用于挛缩和非挛缩的类风湿性鹅颈畸形。它可在PIP关节及远端指间关节（DIP关节）水平矫正畸形。
