Department of Orthopaedic Surgery, Nagoya Ekisaikai Hospital, 4-66 Shonen-Cho, Nakagawa-Ku, Nagoya city, Aichi prefecture, 454-8502, Japan.
Department of Orthopaedic Surgery, Nagoya Ekisaikai Hospital, 4-66 Shonen-Cho, Nakagawa-Ku, Nagoya city, Aichi prefecture, 454-8502, Japan.
J Plast Reconstr Aesthet Surg. 2018 Oct;71(10):1440-1445. doi: 10.1016/j.bjps.2018.05.031. Epub 2018 Jun 8.
Central slip tears often occur with concomitant hand injuries. However, the outcome of a central slip tear and the effect of concomitant injuries are rarely reported. We evaluated 67 fingers in 63 patients with central slip tears who underwent primary surgery in our hospital between April 2009 and June 2017. We performed multivariate analyses, with proximal interphalangeal (PIP) joint active range of motion (AROM) and existing extension lag greater than 10° as dependent variables and age, existence of concomitant fractures, skin defects, collateral ligament injuries, ruptured lateral bands, ruptured flexor tendons or vascular injury in the injured finger as independent variables. Concomitant injuries of tendons in the adjacent fingers were also independent variables. The average AROM of the PIP joint was 62°, and extension lag occurred in 34 fingers (51%). Patients aged > 40 years with fractures of the injured finger or flexor tendon injuries in an adjacent finger had low decreases in AROM (partial regression coefficient [95% confidence interval, CI]: -13.7 [43-66], -31.6 [30-57], -34.5 [32-60] and -33.5 [10-43]). Extensor tendon injuries in an adjacent finger caused significantly more extension lag in the PIP joint (odds ratio [95% CI]: 3.2 [1.0-9.6]). The present study indicated the negative impact of a tendon injury on adjacent fingers, a circumstance widely known as the quadriga phenomenon. Ultimately, we can use these prognostic factors in surgical repair planning, particularly when comparing treatments such as central slip reconstruction and primary arthrodesis.
中央束撕裂常伴有手部损伤。然而，中央束撕裂的结果和伴随损伤的影响很少有报道。我们评估了 2009 年 4 月至 2017 年 6 月期间在我院接受初次手术的 63 例患者的 67 个手指的中央束撕裂。我们进行了多变量分析，以近节指间关节（PIP）关节主动活动度（AROM）和存在的伸展滞后大于 10°为因变量，以年龄、伴发骨折、皮肤缺损、侧副韧带损伤、侧副韧带撕裂、屈肌腱撕裂或受伤手指的血管损伤为自变量。相邻手指的肌腱伴发损伤也是自变量。PIP 关节的平均 AROM 为 62°，有 34 个手指（51%）出现伸展滞后。年龄>40 岁的患者、受伤手指骨折或相邻手指屈肌腱损伤的患者，其 AROM 下降幅度较小（偏回归系数[95%置信区间，CI]：-13.7[43-66]、-31.6[30-57]、-34.5[32-60]和-33.5[10-43]）。相邻手指伸肌腱损伤导致 PIP 关节伸展滞后明显增加（比值比[95%CI]：3.2[1.0-9.6]）。本研究表明，相邻手指的肌腱损伤会产生负面影响，这种情况通常被称为四马驾车现象。最终，我们可以在手术修复计划中使用这些预后因素，特别是在比较中央束重建和初次关节融合等治疗方法时。
