Houshian Shirzad, Jing Shan Shan, Kazemian Gholam Hussein, Emami-Moghaddam-Tehrani Mohammad
Department of Orthopaedic Surgery, Braintree Community Hospital, Mid Essex, United Kingdom; The Department of Plastic Surgery, Broomfield Hospital, Chelmsford, Mid Essex, United Kingdom; Department of Orthopaedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran.
J Hand Surg Am. 2013 Oct;38(10):1951-6. doi: 10.1016/j.jhsa.2013.07.007. Epub 2013 Sep 8.
To report the medium- to long-term outcomes of joint distraction using a unilateral external fixator in the treatment of chronic post-traumatic proximal interphalangaeal (PIP) joint contractures.
Between September 2001 and October 2011, 94 consecutive patients (98 PIP joints) with a mean age of 43 years (range, 17-69 y) were treated with external fixation for chronic flexion deformity of the PIP joint from trauma. The average time from injury to surgery was 48 months (range, 6-84 mo), and the duration of joint distraction was 10 days (range, 7-22 d). Patients were followed for a mean period of 54 months (range, 12-72 mo).
The average gain in joint flexion was 25° and in joint extension was 40°. The mean improvement in the active range of movement was 67° (range. 30°-90°). There was no loss of motion on the latest follow-up. Patients younger than 40 years fared slightly better than those older than 40 years. Two patients developed swelling, pain, and erythema during treatment, which resolved upon temporarily stopping the distraction process. There were 12 cases of superficial pin-site infections, which were managed conservatively without serious complications or adverse outcome.
External fixation is a simple and effective treatment modality for chronic traumatic PIP joint contractures with good predictable medium- to long-term results. Careful patient selection and monitoring are required.
报告使用单侧外固定器进行关节牵张治疗创伤后慢性近端指间（PIP）关节挛缩的中长期疗效。
2001年9月至2011年10月，连续94例患者（98个PIP关节）接受外固定治疗创伤后PIP关节慢性屈曲畸形，平均年龄43岁（范围17 - 69岁）。受伤至手术的平均时间为48个月（范围6 - 84个月），关节牵张持续时间为10天（范围7 - 22天）。患者平均随访54个月（范围12 - 72个月）。
关节屈曲平均增加25°，关节伸展平均增加40°。活动范围平均改善67°（范围30° - 90°）。末次随访时无活动度丢失。40岁以下患者的情况略优于40岁以上患者。2例患者在治疗期间出现肿胀、疼痛和红斑，暂停牵张过程后症状缓解。有12例浅表针道感染，经保守治疗，未出现严重并发症或不良后果。
外固定是治疗创伤后慢性PIP关节挛缩的一种简单有效的治疗方式，中长期疗效可预测。需要仔细选择患者并进行监测。
