Halát Gabriel, Negrin Lukas, Erhart Jochen, Ristl Robin, Hajdu Stefan, Platzer Patrick
University Clinic for Trauma Surgery, Medical University Vienna, Währinger Gürtel, 18-20, 1090, Vienna, Austria.
Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Arch Orthop Trauma Surg. 2017 Feb;137(2):285-292. doi: 10.1007/s00402-016-2619-1. Epub 2017 Jan 10.
The objective of this retrospective review was to evaluate the functional and esthetic outcomes in patients with non- or minimally (<2 mm), and severely (>2 mm) displaced bony avulsions of the flexor digitorum profundus (FDP) tendon.
Between 1996 and 2010, 29 patients with a bony avulsion of the FDP tendon were treated. The displacement magnitude of the avulsed fragment determined, whether conservative or surgical treatment was performed. Persisting functional deficit, radiological findings, remaining disabilities using the Disability of the Arm, Shoulder, and Hand (DASH) score, as well as treatment-related deformities and complications were evaluated retrospectively and at a mean follow-up of 7 years.
In 16 patients, conservative therapy by initial static splinting due to a fragment displacement of <2 mm was conducted. These patients reported no functional impairment at follow-up. In 13 cases, major displacement (>2 mm) of the bony fragment led to an open reconstruction of the avulsion injury either by screw fixation or a Lengemann pull-out wire. In a majority, an extension deficit in the DIP joint and a decrease of tip pinch strength by 25% was present at follow-up. In five patients, peri- or short-term postoperative complications occurred and in five, a nail deformity remained. DASH score revealed satisfying results after both therapeutic approaches.
Conservative treatment in non- or minimally displaced avulsions leads to satisfying functional results. Patients receiving surgery after major fragment displacement need to be aware of a possible impaired ROM at the DIP joint. The use of the Lengemann pull-out wire may place patients at an increased complication risk and frequently induces nail deformities.
Therapeutic, level IV.
本回顾性研究的目的是评估指深屈肌腱（FDP）非移位或轻度（<2mm）和重度（>2mm）移位骨撕脱患者的功能和美学结果。
1996年至2010年期间，对29例FDP肌腱骨撕脱患者进行了治疗。根据撕脱碎片的移位程度决定采用保守治疗还是手术治疗。对持续存在的功能缺陷、影像学表现、使用手臂、肩部和手部功能障碍（DASH）评分评估的残留残疾情况，以及与治疗相关的畸形和并发症进行回顾性评估，平均随访7年。
16例患者因碎片移位<2mm，最初采用静态夹板进行保守治疗。这些患者在随访时未报告功能受损。13例患者中，骨碎片的严重移位（>2mm）导致通过螺钉固定或Lengemann拔出钢丝对撕脱伤进行开放性重建。大多数患者在随访时存在远侧指间关节（DIP）伸展功能缺陷，指尖捏力下降25%。5例患者发生围手术期或短期术后并发症，5例患者残留指甲畸形。两种治疗方法后的DASH评分均显示出满意的结果。
非移位或轻度移位撕脱伤的保守治疗可获得满意的功能结果。主要碎片移位后接受手术的患者需要意识到DIP关节可能存在活动度受损。使用Lengemann拔出钢丝可能会增加患者的并发症风险，并经常导致指甲畸形。
治疗性，IV级。
