Goldner J L, Koman L A, Gelberman R, Levin S, Goldner R D
Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina 27710.
Clin Orthop Relat Res. 1990 Apr(253):75-89.
A hypermobile hyperextension or hyperflexion deformity of the metacarpophalangeal (MCP) joint associated with thumb-in-palm deformity in 90 patients affected by cerebral palsy was treated by arthrodesis with or without soft-tissue procedures. Twenty-two of these patients were adults with closed physes, and 68 were children or adolescents with open growth plates. The MCP joint fusion was usually accompanied by intrinsic muscle lengthening and/or extrinsic tendon transfer, but occasionally it was the only procedure performed to diminish the thumb-in-palm position. Even in four-year-olds, joint fusion was a predictable procedure to establish stability of that joint without disturbing longitudinal or circumferential growth. Measurable function was improved to a mild or moderate degree in 44 of the 50 children who were followed to maturity. Eighteen of the 68 children were unavailable for follow-up evaluation. Six of the 50 followed patients showed no functional improvement, although arthrodesis of the MCP joint occurred in four of the six. The other two patients were operated on when they were 12 years of age and developed a fibrous union that was painless and stable when they were adults. Even those patients who had no functional improvement did have improved appearance and easier control of the affected hand when it was manipulated by the opposite hand. The children were followed to maturity with age-matched cerebral palsy control patients. There was no significant disturbance in growth of those thumbs that had MCP joint fusion when the physes were open.
对90例患有脑瘫且伴有掌指关节（MCP）关节活动过度伸展或过度屈曲畸形及拇指内收畸形的患者，采用关节固定术并酌情联合软组织手术进行治疗。其中22例为成年患者，其骨骺已闭合；68例为儿童或青少年患者，其生长板未闭合。MCP关节融合术通常伴有内在肌延长和/或外在肌腱转移，但偶尔它是为减轻拇指内收畸形而实施的唯一手术。即使对于4岁的儿童，关节融合术也是一种可预测的手术，可在不干扰纵向或周向生长的情况下建立该关节的稳定性。在随访至成年的50名儿童中，44名的可测量功能有轻度或中度改善。68名儿童中有18名无法进行随访评估。在随访的50名患者中，有6名虽接受了MCP关节融合术，但功能未改善。另外两名患者在12岁时接受手术，成年后形成了无痛且稳定的纤维性骨连接。即使是那些功能未改善的患者，当患手由对侧手操作时，外观也有所改善，且对患手的控制更容易。对这些儿童与年龄匹配的脑瘫对照患者进行随访直至成年。当生长板未闭合时，接受MCP关节融合术的拇指生长未受到明显干扰。
