Vicar A J
Indiana University School of Medicine, Indianapolis.
Hand Clin. 1988 Feb;4(1):5-13.
Injuries to the proximal interphalangeal joint are extremely common. An understanding of the complex anatomy of this joint is essential for diagnosis and treatment of proximal interphalangeal joint sprains and dislocations. Lateral injuries are among the commonest injuries in the hand. These are often stable after reduction, requiring only closed treatment. Occasionally, however, the collateral ligament can be trapped in the joint and require open reduction. Dorsal dislocations represent the most common dislocation in the hand. These, too, are usually stable after reduction and can be treated by closed methods. On occasion, however, these dislocations will be open or irreducible by closed means, requiring surgical intervention and repair of damaged structures. Complex rotary dislocations are exactly that: complex. An exact understanding of the damaged structures and causes of irreducibility frequently makes this an injury often requiring open reduction and selective repair of damaged soft tissue structures. Fortunately, prompt diagnosis, reduction, and institution of appropriate treatment can usually afford the patient good function after these injuries. It must be noted that stiffness is more common than instability, and active range-of-motion exercises instituted at the proper time are essential. These joints will often remain permanently thicker after injury in spite of optimal care, and tenderness and soreness with use may persist for 6 to 12 months.
近端指间关节损伤极为常见。了解该关节复杂的解剖结构对于近端指间关节扭伤和脱位的诊断及治疗至关重要。外侧损伤是手部最常见的损伤之一。复位后通常较为稳定，仅需闭合治疗。然而，偶尔侧副韧带可能会陷入关节内，需要切开复位。背侧脱位是手部最常见的脱位类型。同样，复位后通常也较稳定，可采用闭合方法治疗。不过，有时这些脱位会是开放性的或无法通过闭合手段复位，需要手术干预并修复受损结构。复杂旋转脱位确实很复杂。准确了解受损结构及无法复位的原因常常使得这种损伤通常需要切开复位并选择性修复受损的软组织结构。幸运的是，及时诊断、复位并采取适当治疗，通常能使患者在这些损伤后获得良好功能。必须注意的是，僵硬比不稳定更为常见，在适当时间进行主动活动度练习至关重要。尽管给予了最佳护理，这些关节受伤后通常会永久性地变粗，使用时的压痛和酸痛可能会持续6至12个月。
