Matheron A-S, Gouzou S, Collon S, Bodin F, Facca S, Liverneaux P
Department of Hand Surgery, Strasbourg University Hospital, FMTS, 10, avenue Baumann, 67403 Illkirch, France.
Department of Orthopedic Surgery, Caen University Hospital "Côte-de-Nacre", 14040 Caen cedex, France.
Chir Main. 2015 Jun;34(3):134-40. doi: 10.1016/j.main.2015.03.002. Epub 2015 May 8.
The main complications in distal interphalangeal (DIP) fusion are non-union and hardware-related symptoms. The primary aim of this study was to show that joint preparation for DIP fusion is not necessary in cases of stage IV chondropathy. The secondary aim was to show that use of buried compression screws decreases the complication rate. This continuous retrospective study included two groups of DIP percutaneous arthrodesis procedures carried out with 1.8mm break-away compression screws: group 1 underwent joint preparation through a dorsal approach and group 2 underwent a percutaneous procedure without joint preparation. Group 1 included 15 patients (18 fingers) with a mean age of 65.3 years, representing nine cases of osteoarthritis, four cases of open trauma, one of gout, and one of rheumatoid arthritis. Group 2 included 18 patients (21 fingers) with a mean age of 58.9 years, representing 16 cases of osteoarthritis, one of rheumatoid arthritis and one of swan-neck deformity. Tourniquet time was longer in group 1 (61min) than in group 2 (24min). The amount of emitted ionizing radiation was not different between groups. Pain and QuickDASH scores were not improved in group 1 but they were in group 2. There was no difference in the fusion time. One non-union was observed in group 1. Our results show that joint preparation for DIP arthrodesis is unnecessary in stage IV chondropathy. No hardware-related complications were observed.
III.
远侧指间关节（DIP）融合的主要并发症是不愈合和与内固定相关的症状。本研究的主要目的是表明，在IV期软骨病病例中，DIP融合的关节准备是不必要的。次要目的是表明，使用埋头加压螺钉可降低并发症发生率。这项连续性回顾性研究纳入了两组采用1.8mm可折断加压螺钉进行的DIP经皮关节固定术：第1组通过背侧入路进行关节准备，第2组采用不经关节准备的经皮手术。第1组包括15例患者（18指），平均年龄65.3岁，其中骨关节炎9例、开放性创伤4例、痛风1例、类风湿关节炎1例。第2组包括18例患者（21指），平均年龄58.9岁，其中骨关节炎16例、类风湿关节炎1例、鹅颈畸形1例。第1组的止血带时间（61分钟）长于第2组（24分钟）。两组之间的电离辐射剂量无差异。第1组的疼痛和QuickDASH评分未改善，但第2组改善了。融合时间无差异。第1组观察到1例不愈合。我们的结果表明，IV期软骨病患者进行DIP关节固定术时无需进行关节准备。未观察到与内固定相关的并发症。
III级。
