Vitale Mark A, White Neil J, Strauch Robert J
Department of Orthopaedic Surgery, New York-Presbyterian Medical Center, Columbia University, New York, NY 10032, USA.
J Hand Surg Am. 2011 Sep;36(9):1453-9. doi: 10.1016/j.jhsa.2011.06.022. Epub 2011 Aug 6.
Unstable dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint are complex injuries that are difficult to treat and usually require operative fixation. There are a number of surgical techniques for treating these injuries but none has emerged as superior. The purposes of this study were to describe a simple percutaneous technique to treat unstable dorsal fracture-dislocations of the PIP joint and to report short-term postoperative results.
We treated 6 patients with unstable dorsal fracture-dislocations of the PIP joint with the technique of closed reduction, percutaneous fracture reduction, and pinning via a volar approach and also with dorsal block pinning. We collected information on postoperative stability, range of motion at the PIP and distal interphalangeal joints, and radiographic outcomes. We also administered the Disabilities of the Arm, Shoulder, and Hand and visual analog pain scale questionnaires.
At a mean follow-up of 18 months (range, 6-57 mo), there were no subluxation or dislocation events. The mean range of motion was from 4° of extension to 93° of flexion at the PIP joint and from 1° of extension to 73° of flexion at the distal interphalangeal joint. Radiographic analysis revealed a concentric reduction and union in all cases. The mean Disabilities of the Arm, Shoulder, and Hand score was 8 and the mean visual analog pain score was 1.4 out of 10. There were no minor or major complications.
This percutaneous technique reliably restored stability to the PIP joint, allowed for concentric reduction of the joint, and produced excellent radiographic and clinical outcomes. The postoperative management course with this technique is critical to the outcome.
近端指间关节（PIP）不稳定的背侧骨折脱位是复杂损伤，治疗困难，通常需要手术固定。治疗这些损伤有多种手术技术，但尚无一种脱颖而出。本研究的目的是描述一种治疗PIP关节不稳定背侧骨折脱位的简单经皮技术，并报告术后短期结果。
我们采用闭合复位、经皮骨折复位以及经掌侧入路穿针固定技术和背侧阻挡穿针技术治疗6例PIP关节不稳定背侧骨折脱位患者。我们收集了有关术后稳定性、PIP关节和远端指间关节活动范围以及影像学结果的信息。我们还发放了手臂、肩部和手部功能障碍问卷以及视觉模拟疼痛量表问卷。
平均随访18个月（范围6 - 57个月），未发生半脱位或脱位事件。PIP关节平均活动范围从伸直4°至屈曲93°，远端指间关节从伸直1°至屈曲73°。影像学分析显示所有病例均实现同心复位和愈合。手臂、肩部和手部功能障碍平均评分为8分，视觉模拟疼痛平均评分为1.4分（满分10分）。未发生轻微或严重并发症。
这种经皮技术可靠地恢复了PIP关节的稳定性，实现了关节的同心复位，并产生了优异的影像学和临床结果。采用该技术的术后管理过程对结果至关重要。
