Towfigh H, Clausing A
Abteilung für Unfallchirurgie, Universitätsklinikum Essen.
Handchir Mikrochir Plast Chir. 1989 Sep;21(5):270-5.
Late results following operative and conservative treatment of 215 ligamentous injuries with injured metacarpophalangeal and interphalangeal joints are presented. These 215 cases represent 77,4% of all hand injuries which were treated in the years 1976 to 1981 at the Traumatological Department of Essen University. Mobility, stability, and function were used to evaluate and compare the late results. A modification of the scheme of Buck-Gramcko et al. for the evaluation of finger's mobility after flexor tendon injuries was employed. 75% of late results were judged to be "good to very good", 16,5% "satisfactory", and 8,5% "poor". The most important influences on the late results were found to be the time between injury and treatment and the patient's age. Further factors were open injuries and the destruction of large parts of the palmar plate. The late results in cases after surgery were much better than those after conservative treatment. Only injuries without total rupture of the palmar plate or collateral ligaments - which were in nearly all cases treated conservatively - reached good or very good late results in over 90%. A better evaluation of the bony injuries could be achieved by special X-ray technique such as magnification views of the involved joints. If the duration of immobilisation is shortened a better restoration of full joint mobility is ensured without disturbing joint stability.
本文报告了215例掌指关节和指间关节韧带损伤经手术及保守治疗后的远期疗效。这215例病例占1976年至1981年埃森大学创伤科收治的所有手部损伤的77.4%。采用活动度、稳定性和功能来评估和比较远期疗效。采用了Buck - Gramcko等人的方案改良版来评估屈指肌腱损伤后手指的活动度。75%的远期疗效被判定为“良好至非常好”，16.5%为“满意”，8.5%为“差”。发现对远期疗效最重要的影响因素是受伤与治疗之间的时间间隔以及患者年龄。其他因素包括开放性损伤和掌板大部分破坏。手术治疗病例的远期疗效远优于保守治疗病例。只有掌板或侧副韧带未完全断裂的损伤（几乎所有这些病例均采用保守治疗），超过90%能达到良好或非常好的远期疗效。通过特殊的X线技术，如受累关节的放大视图，可以更好地评估骨损伤。如果缩短固定时间，可以确保关节完全活动度更好地恢复，同时不影响关节稳定性。
