Clement R, Wray R C
Division of Plastic Surgery, Washington University, St Louis, MO.
Ann Plast Surg. 1986 Feb;16(2):136-41. doi: 10.1097/00000637-198602000-00010.
Forty-four patients with 47 mallet fingers were reviewed to compare the results of operative (24 fingers) and nonoperative (23 fingers) treatment. Distal interphalangeal (DIP) joint extension, DIP flexion, total active motion of the DIP joint, proximal interphalangeal (PIP) extension, PIP flexion, total active motion of the PIP joint, cold intolerance, and persistent pain after treatment were not significantly different in patients treated by surgery or splinting. Secondarily, we compared fingers with and without a fracture of the distal phalanx, and the variables mentioned above were also unaffected by the presence or absence of fractures of the distal phalanx. About one-third of all patients had decreased PIP joint motion following treatment. In about 16% of all patients this loss of PIP motion was more important in determining finger function than DIP motion or symptoms related to the DIP joint. We recommend careful examination of the PIP joint and repeated monitoring of the joint motion. If the PIP joint becomes stiff, therapy and splinting should be used to minimize permanent stiffness. We believe a prospective randomized comparison of operative and nonoperative treatment of mallet finger should be conducted. Such a study would help determine the ideal treatment for mallet finger.
回顾了44例患有47根锤状指的患者，以比较手术治疗（24根手指）和非手术治疗（23根手指）的结果。手术治疗或夹板固定治疗的患者，其远侧指间关节（DIP）伸展、DIP屈曲、DIP关节总主动活动度、近侧指间关节（PIP）伸展、PIP屈曲、PIP关节总主动活动度、不耐冷以及治疗后持续疼痛等方面无显著差异。其次，我们比较了有和无远节指骨骨折的手指，上述变量也不受远节指骨骨折存在与否的影响。所有患者中约三分之一在治疗后出现PIP关节活动度下降。在所有患者中约16%的这种PIP活动度丧失在决定手指功能方面比DIP活动度或与DIP关节相关的症状更重要。我们建议仔细检查PIP关节并反复监测关节活动度。如果PIP关节变得僵硬，应采用治疗和夹板固定以尽量减少永久性僵硬。我们认为应该对锤状指的手术和非手术治疗进行前瞻性随机对照比较。这样的研究将有助于确定锤状指的理想治疗方法。
