From the Department of Plastic and Reconstructive Surgery and the Rehabilitation Center, Chang Gung Memorial Hospital, Linkou Medical Center; Chang Gung University College of Medicine; and St. Andrew's Center for Plastic Surgery and Burns, Broomfield Hospital.
Plast Reconstr Surg. 2020 Feb;145(2):445-455. doi: 10.1097/PRS.0000000000006472.
Posttraumatic proximal interphalangeal (PIP) joint contractures of the digits are common and are associated with impaired hand function. However, relapse is common after surgical release of PIP joint contractures. This article presents a novel treatment strategy with a PIP joint adipofascial flap to resurface the joint after release, and compares patients with similar joint contracture release who did and did not undergo resurfacing with a PIP joint adipofascial flap.
From January of 2010 to January of 2018, 10 patients received single-digit PIP joint flexion contracture release and PIP joint adipofascial flap resurfacing; 20 patients received a stepwise release as a control group. Thirty joints were compared, and the degree of extension lag improvement over time was measured during an average follow-up period of 292.4 days.
Greater extension lag improvement was observed in the PIP joint adipofascial flap group compared with the control group (37.0 ± 19.2 degrees versus 21.0 ± 19.5 degrees; p =0.055). The ratio of improvement was also significantly higher in the flap group (0.79 ± 0.26 versus 0.49 ± 0.46; p =0.049). Flap resurfacing appeared to have a beneficial effect on improvements in extension lag (p =0.042), whereas a higher number of secondary operations, associated fractures, and maximum visual analogue scale score 1 week postoperatively were negatively associated with extension lag in univariate analysis (p < 0.05). Generalized estimating modeling showed that flap resurfacing had a significantly positive effect on extensor lag improvement with time (β = 2.235; p =0.04).
PIP joint adipofascial flap resurfacing following PIP joint contracture release may improve and maintain extensor lag. Recovery of joint motion may also be quicker compared with conventional release alone.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
手指外伤性近节指间关节（PIP）关节挛缩很常见，且与手部功能受损有关。然而，PIP 关节挛缩松解术后复发很常见。本文提出了一种新的治疗策略，即使用 PIP 关节脂肪筋膜皮瓣对关节进行再皮瓣覆盖，比较了接受 PIP 关节松解联合脂肪筋膜皮瓣再皮瓣覆盖和单纯接受 PIP 关节松解的具有相似关节挛缩的患者。
从 2010 年 1 月至 2018 年 1 月，10 例患者接受单指 PIP 关节屈曲挛缩松解联合 PIP 关节脂肪筋膜皮瓣再皮瓣覆盖；20 例患者作为对照组接受分步松解。共比较了 30 个关节，平均随访 292.4 天，测量了关节活动度的改善情况。
PIP 关节脂肪筋膜皮瓣组的关节活动度改善程度明显大于对照组（37.0±19.2 度 vs 21.0±19.5 度；p=0.055）。皮瓣组的改善率也明显更高（0.79±0.26 比 0.49±0.46；p=0.049）。皮瓣再皮瓣覆盖似乎对改善关节活动度有积极影响（p=0.042），而在单因素分析中，二次手术、相关骨折和术后 1 周最大视觉模拟评分较高与关节活动度延迟呈负相关（p<0.05）。广义估计模型显示，皮瓣再皮瓣覆盖对关节活动度延迟的改善具有显著的正时间效应（β=2.235；p=0.04）。
PIP 关节挛缩松解后皮瓣再皮瓣覆盖可能改善和维持关节活动度。与单纯松解相比，关节活动度的恢复可能更快。
临床问题/证据水平：治疗性，III 级。
