Morgan Emily N, Means Kenneth R, Paez Adrian G, Parks Brent G, Innis Peter C
1 Walter Reed National Military Medical Center, Bethesda, MD, USA.
2 The Curtis National Hand Center, Baltimore, MD, USA.
Hand (N Y). 2018 Jul;13(4):435-440. doi: 10.1177/1558944717715104. Epub 2017 Jun 30.
The purpose of this study was to determine whether placing the suture-button device between the long and small finger metacarpals following ring finger ray amputation may better close the intermetacarpal gap and allow early range of motion without increasing the risk of malrotation than soft tissue repair alone.
We performed ray amputation of the ring finger of 14 cadaver specimens by performing an osteotomy of the base of the ring finger metacarpal and then excising the remainder of the digit. We first performed a soft tissue repair of the transverse metacarpal ligaments and then cycled the fingers in simulated active flexion and extension on a custom computer-controlled device to re-create 6 weeks of range of motion. We then placed a suture-button device across the long and small finger metacarpals and tested the specimens again, thereby using each hand as an internal control.
The distance between the ring and small finger metacarpals was reduced following suture-button device placement compared with the initial control; this spacing was maintained following complete cycling of the fingers. The angle between the metacarpals was divergent following soft tissue repair, and then became slightly convergent after insertion of the suture-button device. None of the hands developed clinically relevant scissoring of the digits before or after application of the suture-button device.
The suture-button device provides stable fixation to withstand early range of motion following ring finger ray amputation and significantly closes the gap and angle between the adjacent metacarpals without causing scissoring.
本研究的目的是确定在无名指射线截肢后，将缝线纽扣装置置于食指和小指掌骨之间，与单纯软组织修复相比，是否能更好地闭合掌骨间隙并允许早期活动范围，同时不增加旋转不良的风险。
我们对14个尸体标本的无名指进行射线截肢，方法是对无名指掌骨基部进行截骨术，然后切除手指的其余部分。我们首先对掌横韧带进行软组织修复，然后在定制的计算机控制装置上模拟手指主动屈伸，以重现6周的活动范围。然后我们在食指和小指掌骨之间放置缝线纽扣装置，并再次测试标本，从而将每只手作为自身对照。
与初始对照相比，放置缝线纽扣装置后，无名指和小指掌骨之间的距离减小；手指完全屈伸循环后，该间距保持不变。软组织修复后掌骨之间的角度呈散开状，插入缝线纽扣装置后角度略有收敛。在应用缝线纽扣装置之前或之后，没有一只手出现临床上相关的手指交叉。
缝线纽扣装置提供稳定的固定，以承受无名指射线截肢后的早期活动范围，并显著闭合相邻掌骨之间的间隙和角度，而不会导致交叉。
