Brulard C, Sauvage A, Mares O, Wavreille G, Fontaine C
Service d'orthopédie B, hôpital Roger-Salengro, CHRU de Lille, rue Emile-Laine, 59037 Lille cedex, France.
Chir Main. 2012 Jun;31(3):118-27. doi: 10.1016/j.main.2012.04.010. Epub 2012 May 11.
Surgical treatment of finger swan neck deformities is versatile. We aimed to assess the outcome of PIP tenodesis on unfixed deformities, in patients suffering from rheumatoid arthritis.
Twenty-three PIP tenodeses were performed on eight patients, using half of a superficialis flexor digitorum tendon sutured to A2 pulley through a volar approach. Postoperative splinting, in 20° of PIP flexion, was maintained for 4 weeks. The patients were assessed retrospectively, at a mean period of 61 months.
The PIP flexion gained 26°. On the other hand, a 4°-flexion contraction was induced. The mean postoperative flexion reached 65°. The PIP hyperextension was corrected by 33°. In one same patient, the correction was insufficient for the four fingers. The DIP lack of extension was totally corrected in 70% of the cases and partially in 30%. Each patient had functional improvement. Nineteen good and excellent, and four fair results were reported. No major complication was observed.
This tenodesis seems to be reliable and to give good long-term results. It is our intervention of choice for rheumatoid flexible swan-neck deformity.
手指鹅颈畸形的手术治疗方法多样。我们旨在评估类风湿关节炎患者中，近端指间关节（PIP）固定术对未固定畸形的治疗效果。
对8例患者进行了23次近端指间关节固定术，采用掌侧入路，将一半指浅屈肌腱缝合至A2滑车。术后在近端指间关节屈曲20°位进行夹板固定，持续4周。对患者进行回顾性评估，平均随访时间为61个月。
近端指间关节屈曲增加了26°。另一方面，导致了4°的屈曲挛缩。术后平均屈曲度达到65°。近端指间关节过伸矫正了33°。在同一例患者中，4根手指的矫正效果欠佳。70%的病例中远端指间关节（DIP）伸直受限完全得到矫正，30%部分得到矫正。每位患者的功能均有改善。报告了19例优和良的结果，4例为尚可。未观察到重大并发症。
这种固定术似乎可靠，且能取得良好的长期效果。它是我们治疗类风湿性柔性鹅颈畸形的首选干预方法。
