Pillukat T, Ritter S, Fuhrmann R A, Windolf J, van Schoonhoven J
Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland.
Oper Orthop Traumatol. 2013 Aug;25(4):331-9. doi: 10.1007/s00064-012-0207-2. Epub 2013 Aug 14.
The aim is correction of claw deformity of the fingers by intrinsic paralysis.
Indications are claw deformity of fingers caused by palsy or functional loss of the interosseus or lumbrical muscles as far as the function of the superficial and deep flexors of the finger is intact.
Contraindications are loss or paralysis of finger flexors supplied by the median nerve, fixed extension or flexion contracture of the finger joints, osteoarthritis and other malfunctions of the finger joints, no active flexion and extension of the interphalangeal joints due to compromised tendon gliding. Relative: Upper ulnar nerve palsy with functional loss of the deep flexor of the small and ring finger and possibly of the middle finger.
The operation technique involves detachment of the flexor digitorum superficialis IV tendon (FDS IV) distal to Camper's chiasm, division of the tendon into separate strips, interweaving of each tendon strip into the proximal part of the A2 pulley of the affected fingers. In cases of claw deformity of all fingers it may be advantageous to apply the superficial flexor tendon of the long finger in addition to the FDS IV tendon as otherwise the FDS IV tendon has to be divided into four strips resulting in relatively thin tendon strips. If the FDS III and IV tendons are applied, the two strips of the FDS IV tendon are used for lassoplasty of the small and ring fingers and the FDS III tendon for lassoplasty of the middle and index fingers.
Postoperative management includes immobilization of the operated fingers by a dorsoulnar forearm plaster cast including the metacarpophalangeal joints which are flexed to 70°. After 2 weeks replacement of the cast by a thermoplastic splint for another 4 weeks. During the whole period exercises for the finger and thumb should be carried out.
From April 2003 to June 2012 a total of 17 patients, 8 female and 9 male were surgically treated for claw deformity. The dominant hand was affected in seven patients. The average age was 46 ± 15 (22-80) years, the average interval from onset of ulnar palsy to lassoplasty was 61 ± 91 (3-288) months. The final follow-up was performed after an average of 42 ± 32 (2-112) months. Claw deformity was resolved in 14 out of the 17 patients. The grip strength was on average 58 ± 28 % (11-96 %) of the unaffected hand, the mean disabilities of the arm, shoulder and hand (DASH) score was 32 ± 18 (5-68) points and the degree of patient satisfaction 7 ± 2 (0-10). According to own results and those in the literature lassoplasty can be recommended for the treatment of claw deformity.
旨在通过内在肌麻痹来矫正手指的爪形畸形。
适应证为因骨间肌或蚓状肌麻痹或功能丧失导致的手指爪形畸形，前提是手指的浅、深屈肌功能完好。
禁忌证包括正中神经支配的手指屈肌丧失或麻痹、手指关节固定性伸直或屈曲挛缩、手指关节骨关节炎及其他功能障碍、因肌腱滑动受损导致指间关节无法主动屈伸。相对禁忌证：尺神经高位麻痹导致小指、环指及可能的中指深屈肌功能丧失。
手术操作包括在坎珀交叉（Camper's chiasm）远端切断指浅屈肌IV肌腱（FDS IV），将肌腱分成单独的条带，将每条肌腱条带交织到患指A2滑车的近端部分。若所有手指均有爪形畸形，除FDS IV肌腱外，应用示指浅屈肌腱可能更有利，否则FDS IV肌腱需分成四条带，导致肌腱条带相对较细。若应用FDS III和IV肌腱，FDS IV肌腱的两条带用于小指和环指的束带成形术，FDS III肌腱用于中指和示指的束带成形术。
术后处理包括用背尺侧前臂石膏固定手术手指，包括掌指关节屈曲至70°。2周后更换为热塑性夹板，再固定4周。在整个期间应进行手指和拇指的锻炼。
2003年4月至2012年6月，共有17例患者接受了爪形畸形的手术治疗，其中女性8例，男性9例。7例患者优势手受累。平均年龄为46±15（22 - 80）岁，从尺神经麻痹发作到束带成形术的平均间隔时间为61±91（3 - 288）个月。平均随访42±32（2 - 112）个月后进行最终随访。17例患者中有14例爪形畸形得到矫正。握力平均为健侧手的58±28%（11 - 96%），手臂、肩部和手部的平均残疾指数（DASH）评分为32±18（5 - 68）分，患者满意度为7±2（0 - 10）分。根据自身结果及文献报道，束带成形术可推荐用于治疗爪形畸形。
