Mühldorfer-Fodor Marion, Reger Angela, Pillukat Thomas, Mittlmeier Thomas, van Schoonhoven Jörg, Prommersberger Karl-Josef
Rhön-Klinikum, Klinik für Handchirurgie.
Chirurgische Universitätsklinik Rostock Unfall-, Hand- und Wiederherstellungschirurgie.
Handchir Mikrochir Plast Chir. 2018 Jun;50(3):174-183. doi: 10.1055/a-0645-6867. Epub 2018 Jul 25.
Due to the functional coupling of adjacent finger joints and the quadriga effect of the flexor digitorum profundus an influence of the grip pattern of the hand after fusion of a distal interphalangeal joint (DIPJ) is assumed.
Two patients with DIPJ II- fusion and 8 patients with DIPJ III- fusion due to a posttraumatic osteoarthritis, but without any other pathology of both hands were assessed on average 55 (17-121) months postoperatively by manugraphy. Using three sizes of cylinders the total grip force and the load distribution of the hand and each finger were measured. The grip pattern was analyzed by 2D-graphs. The results of the affected hand were compared to the healthy opposite side. The consolidation of the DIPJ arthrodesis was confirmed and the angle of the joint fusion measured by radiographs. Patients rated their pain in rest or under strain by a visual analogue scale.
The total grip force of the affected hand compared to the opposite side was 93 % for the small cylinder, 97 % for the middle, and 96 % for the large cylinder. Both patients with a DIPJ II- fusion neglected the index finger considerably and had a remarkably weak grip force (68/62/68 % for the 3 cylinders respectively). The grip pattern of all fingers has changed. Eight patients with DIPJ III- fusion averaged 99/106/103 % grip force. In six of them, the affected hand was stronger than the opposite hand when using the middle cylinder. The finger force of the middle and ring finger was reduced, but of the index and little finger increased. Five patients had a striking peak of local pressure at the fused DIPJ III.The angle of the fused DIPJ averaged 6° (0-21°) for all patients. Pain was rated on average 1.4 (0-5) at rest and 2 (0-8) with strain. Both aspects were not found to influence the grip force or the load distribution.
After DIPJ- fusion of the middle finger its finger force is reduced; but, the total grip force is compensated by an increased finger force of the index and little finger. Despite limitations due to the small number of patients, a DIPJ II- fusion might have a considerable effect on grip force and load distribution of the hand rather due to omitting this finger than purely biomechanical effects.
由于相邻手指关节的功能耦合以及指深屈肌的协同效应，推测远端指间关节（DIPJ）融合后手的抓握模式会受到影响。
两名因创伤后骨关节炎导致DIPJ II融合的患者以及八名因创伤后骨关节炎导致DIPJ III融合的患者，且双手无任何其他病变，术后平均55（17 - 121）个月接受了手测力检查。使用三种尺寸的圆柱体测量了手和每个手指的总握力以及负荷分布。通过二维图表分析抓握模式。将患侧手的结果与对侧健康手进行比较。通过X线片确认DIPJ关节固定术的愈合情况并测量关节融合角度。患者通过视觉模拟量表对休息或用力时的疼痛进行评分。
与对侧相比，患侧手对于小圆柱体的总握力为93%，中圆柱体为97%，大圆柱体为96%。两名DIPJ II融合患者显著忽视食指且握力明显较弱（三种圆柱体分别为68/62/68%）。所有手指的抓握模式均发生了变化。八名DIPJ III融合患者的握力平均为99/106/103%。其中六名患者在使用中圆柱体时，患侧手比健侧手更强。中指和环指的指力降低，但食指和小指的指力增加。五名患者在融合的DIPJ III处有明显的局部压力峰值。所有患者融合DIPJ的角度平均为6°（0 - 21°）。休息时疼痛平均评分为1.4（0 - 5），用力时为2（0 - 8）。未发现这两方面因素会影响握力或负荷分布。
中指DIPJ融合后其指力降低；但是，总握力通过食指和小指增加的指力得到了补偿。尽管由于患者数量较少存在局限性，但DIPJ II融合可能对手的握力和负荷分布有相当大的影响，这更多是由于该手指的缺失而非纯粹的生物力学效应。
