Terrono A, Millender L
Tuft's University, Boston, Massachusetts.
Hand Clin. 1989 May;5(2):239-48.
The boutonniere deformity is the most common rheumatoid thumb deformity. Its treatment is based on the type or stage of the deformity. We have reviewed our recent cases which are the basis for our current recommendations. MP joint synovectomy and EPL rerouting have a high recurrence rate of 64 per cent. MP joint fusion is the procedure of choice for the moderate type with isolated MP joint involvement. There is a low incidence of later IP joint collapse. MP joint arthroplasty is best suited for the low-demand, older patient with borderline proximal and distal joints. IP joint releases have a high degree of recurrence and are not recommended. In a low-demand patient with an advanced thumb, MP joint arthroplasty and IP joint fusion are the procedures of choice.
纽扣指畸形是类风湿性拇指畸形中最常见的类型。其治疗方法取决于畸形的类型或阶段。我们回顾了近期的病例，这些病例是我们当前建议的依据。掌指关节滑膜切除术和拇长伸肌改道术的复发率高达64%。掌指关节融合术是适用于单纯掌指关节受累的中度畸形类型的首选手术。后期指间关节塌陷的发生率较低。掌指关节置换术最适合对功能要求不高、近端和远端关节处于临界状态的老年患者。指间关节松解术的复发率很高，不建议采用。对于对功能要求不高、拇指畸形严重的患者，掌指关节置换术和指间关节融合术是首选手术。
