Terrono A, Millender L, Nalebuff E
New England Baptist Hospital, Boston, Mass.
J Hand Surg Am. 1990 Nov;15(6):999-1003. doi: 10.1016/0363-5023(90)90032-m.
The boutonniere deformity is the most common rheumatoid thumb deformity. It can be classified into early, moderate, and advanced types, depending on whether the deformity is passively correctable. Fifty-three patients with 74 procedures form the basis of these recommendations. The early type treated with metacarpophalangeal joint synovectomy and extensor pollicis longus rerouting have a high recurrence rate of 64%. Metacarpophalangeal joint fusion is the procedure of choice for the moderate type with isolated metacarpophalangeal joint involvement. Metacarpophalangeal joint arthroplasty is best suited for the low-demand, older patients with borderline proximal and distal joints. Interphalangeal joint releases done with metacarpophalangeal joint fusions have a high recurrence rate and are not recommended. In advanced cases metacarpophalangeal joint arthroplasty and interphalangeal joint fusion is our procedure of choice.
纽扣畸形是类风湿性关节炎最常见的拇指畸形。根据畸形是否可被动矫正，可分为早期、中期和晚期。53例患者接受了74次手术，构成了这些建议的基础。早期类型采用掌指关节滑膜切除术和拇长伸肌改道治疗，复发率高达64%。掌指关节融合术是适用于单纯掌指关节受累的中期类型的首选手术。掌指关节置换术最适合需求较低、近端和远端关节边缘情况的老年患者。掌指关节融合术同时进行指间关节松解术复发率高，不建议采用。在晚期病例中，掌指关节置换术和指间关节融合术是我们的首选手术。
