Liu Kun, Xiong Ge, Yang Chen, Tian Wen, Tian Guanglei
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014 Nov;28(11):1325-8.
To investigate the clinical characteristics, diagnosis, and treatment of metacarpophalangeal (MCP) joint locking with extension lag.
Between February 2009 and April 2014, 17 patients (17 fingers) with MCP joint locking with extension lag were treated. The patients included 4 males and 13 females, and the average age was 40.7 years (range, 20-72 years). The index finger was locked in 12 cases and the middle finger in 5 cases. All patients could not fully extend the MCP joint at about 30° flexion without flexion limitation of the interphalangeal joint. The range of motion (ROM) of the MCP joint was (41.2 ± 5.1)°. The visual analogue scale (VAS) score was 2.7 ± 0.5. X-ray and CT scanning showed that there was a bony prominence on radial condyle of the metacarpal head in 15 primary patients, and a hook like osteophyte on ulnar condyle in 2 degenerative patients. All patients were treated with close reduction first, and open reduction was conducted when the manipulation failed.
Successful close reduction was achieved in 5 cases, and successful open reduction in 8 cases; 4 cases gave up treatment after failure for close reduction. All patients who achieved successful reduction were followed up 2.3 years on average (range, 6 months to 5 years and 2 months). The ROM of the MCP joint was increased to (80.4 ± 6.6)° at last follow-up, showing significant difference when compared with ROM before reduction (t = -19.46, P = 0.00). The VAS score decreased to 0.2 ± 0.4 at last follow-up, also showing significant difference when compared with score before reduction (t = 13.44, P = 0.00).
Accessory collateral ligament caught at the bony prominence on the radial condyle of the metacarpal head is the most common cause of the MCP joint locking with extension lag. Close reduction is feasible, but recurrence of locking is possible. Surgical treatment is advised in the event of manipulation failure or recurrent locking.
探讨伴伸直滞后的掌指关节绞锁的临床特征、诊断及治疗方法。
2009年2月至2014年4月，对17例（17指）伴伸直滞后的掌指关节绞锁患者进行治疗。患者中男性4例，女性13例，平均年龄40.7岁（范围20 - 72岁）。食指绞锁12例，中指绞锁5例。所有患者在掌指关节屈曲约30°时均不能完全伸直，而指间关节无屈曲受限。掌指关节活动度（ROM）为（41.2±5.1）°。视觉模拟评分（VAS）为2.7±0.5。X线及CT扫描显示，15例原发性患者掌骨头桡侧髁有骨性隆起，2例退变患者尺侧髁有钩状骨赘。所有患者均先试行闭合复位，手法失败后行切开复位。
5例闭合复位成功，8例切开复位成功；4例闭合复位失败后放弃治疗。所有复位成功的患者平均随访2.3年（范围6个月至5年2个月）。末次随访时掌指关节ROM增加至（80.4±6.6）°，与复位前ROM相比差异有统计学意义（t = -19.46，P = 0.00）。末次随访时VAS评分降至0.2±0.4，与复位前评分相比差异也有统计学意义（t = 13.44，P = 0.00）。
副侧副韧带卡在掌骨头桡侧髁的骨性隆起处是伴伸直滞后的掌指关节绞锁最常见的原因。闭合复位可行，但有绞锁复发的可能。手法失败或绞锁复发时建议手术治疗。
