Melone Charles P, Dayan Erez
Department of Orthopedic Surgery, Mount Sinai Beth Israel Medical Center, Icahn School of Medicine, New York, NY.
Division of Plastic and Reconstructive Surgery, Brigham & Women's Hospital/Harvard Medical School, Boston, MA.
J Hand Surg Am. 2018 Jun;43(6):574.e1-574.e9. doi: 10.1016/j.jhsa.2018.03.008. Epub 2018 Apr 9.
Hallmark deformities of systemic scleroderma are early onset and progressively disabling flexion contractures of the proximal interphalangeal (PIP) joints often in conjunction with extension or, less frequently, flexion contractures of the metacarpophalangeal (MCP) joints. Although surgical correction is generally recommended, a prevailing reluctance for operative treatment exists owing to the inherent ischemia of the disease with its potentially compromised healing capacity. Nonetheless, with recognition and preservation of the tenuous but well-defined and constant periarticular vascular networks of the PIP and MCP joints, articular reconstruction with uncomplicated wound healing can prove consistently successful for patients with scleroderma. This article describes the authors' preferred methods of PIP arthrodesis vascularized by the dorsal cutaneous arterial network and MCP silicone implant arthroplasty perfused by the dorsal metacarpal arterial plexus.
系统性硬化症的典型畸形表现为近端指间关节（PIP）早期发病且逐渐致残的屈曲挛缩，常伴有掌指关节（MCP）的伸展挛缩，或较少见的屈曲挛缩。尽管通常建议进行手术矫正，但由于该疾病固有的缺血性及其潜在受损的愈合能力，人们普遍不愿接受手术治疗。然而，认识并保留PIP和MCP关节周围脆弱但明确且恒定的血管网络后，对于硬皮病患者而言，关节重建及伤口顺利愈合能够持续取得成功。本文介绍了作者所青睐的方法，即通过背侧皮动脉网进行血管化的PIP关节融合术，以及通过掌背动脉丛灌注的MCP硅胶植入关节成形术。
