Hong Seok Woo, Kim Jihyeung, Kwon Oh Sang, Lee Min Ho, Gong Hyun Sik, Baek Goo Hyun
Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
J Hand Surg Am. 2020 May;45(5):e1-e10. doi: 10.1016/j.jhsa.2019.02.014. Epub 2019 Apr 17.
The aims of this study were to verify proximal phalangeal head normalization after a stretching exercise in patients with infantile-type camptodactyly and to propose radiographic indices for quantifying bony deformities.
Forty-eight fingers of 20 patients with camptodactyly were enrolled in this study. All patients and their parents received instruction on how to perform the stretching exercise. The qualitative assessments of proximal phalangeal head remodeling were conducted by consensus of 2 hand surgeons. Two radiographic parameters, head triangle ratio (HTR) and head angle (HA), were measured on finger lateral radiographs taken at the initial visit and at 12-month follow-up. The intra- and interobserver reliability of both parameters was assessed. Those parameters of the patients were compared with those of 177 fingers of 80 children without camptodactyly. The extent of proximal interphalangeal (PIP) joint flexion contracture was used to evaluate clinical outcomes resulting from nonsurgical treatment.
Qualitative assessments of proximal phalangeal head remodeling exhibited meaningful improvements. Both radiographic parameters showed significant change between their status before and after intervention and had excellent intra- and interobserver reliability. Average PIP joint flexion contracture significantly improved. In the noncamptodactyly group, neither parameter showed significant differences in accordance with finger types and age ranges.
Stretching improved movement within the proximal phalangeal joint and helped to restore proximal phalangeal head roundness and concentricity in patients with infantile-type camptodactyly. The HTR and HA would be useful indices for objectively assessing the degree of bony deformity in patients with camptodactyly.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究旨在验证婴儿型先天性屈曲挛缩畸形患者进行伸展运动后近节指骨头的正常化情况，并提出用于量化骨畸形的影像学指标。
本研究纳入了20例先天性屈曲挛缩畸形患者的48根手指。所有患者及其父母均接受了关于如何进行伸展运动的指导。由2名手外科医生共同对近节指骨头重塑进行定性评估。在初诊时和随访12个月时拍摄手指侧位X线片，测量两个影像学参数，即头三角比（HTR）和头角（HA）。评估了这两个参数在观察者内和观察者间的可靠性。将这些患者的参数与80例无先天性屈曲挛缩畸形儿童的177根手指的参数进行比较。使用近端指间（PIP）关节屈曲挛缩的程度来评估非手术治疗的临床效果。
近节指骨头重塑的定性评估显示出有意义的改善。两个影像学参数在干预前后均有显著变化，并且在观察者内和观察者间具有出色的可靠性。平均PIP关节屈曲挛缩明显改善。在无先天性屈曲挛缩畸形组中，根据手指类型和年龄范围，这两个参数均未显示出显著差异。
伸展运动改善了近节指关节内的活动，并有助于恢复婴儿型先天性屈曲挛缩畸形患者近节指骨头的圆润度和同心度。HTR和HA将是客观评估先天性屈曲挛缩畸形患者骨畸形程度的有用指标。
研究类型/证据水平：治疗性IV级。
