Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
Clin Orthop Surg. 2021 Jun;13(2):243-251. doi: 10.4055/cios20170. Epub 2021 Mar 9.
The rupture of the central slip of an extensor tendon of a finger causes a boutonniere (or buttonhole) deformity, characterized by pathologic flexion at the proximal interphalangeal (PIP) joint and hyperextension at the distal interphalangeal (DIP) joint. Currently, there are no standard treatment guidelines for this deformity. This study aimed to report clinical results of surgery to correct chronic boutonniere deformity.
This retrospective case series was conducted between January 2010 and December 2018 and only 13 patients with trauma-induced chronic deformity were included. After excision of elongated scar tissue, a direct anatomic end-to-end repair using a loop suture technique with supplemental suture anchor augmentation was conducted. Total active motion was assessed before and after surgery and self-satisfaction scores were collected from phone surveys.
All patients presented with Burton stage I deformities defined as supple and passively correctable joints. The initial mean extension lag of the PIP joint (43.5°) was improved by an average of 21.9° at the final follow-up ( < 0.001). The mean hyperextension of the DIP joint averaged 19.2° and improved by 0.8° flexion contracture ( < 0.001). The average total active motion was 220.4° (range, 160°-260°). Based on the Souter's criteria, 69.2% (9/13) of the patients had good results. Only 1 patient reported fair outcome and 23.1% (3/13) reported poor outcome. The average Strickland formula score was 70 (range, 28.6-97.1). In total, 10 patients (77%) had excellent or good results. Of 10 patients contacted by phone, self-reported satisfaction score was very satisfied in 2, satisfied in 3, average in 3, poor in 1, and very poor in 1. Three patients reported a relapse of the deformity during range of motion exercises, 1 of whom underwent revision surgery. One patient complained of PIP joint flexion limitation, and 2 complained of DIP joint flexion limitation at final follow-up.
In chronic boutonniere deformity, central slip reconstruction with anchor suture augmentation can be an easily applicable surgical option, which offers fair to excellent outcome in 77% of the cases. The risk of residual extension lag and recurrence of deformity should be discussed prior to surgery.
手指伸肌腱中央束断裂会导致纽扣畸形（或扣眼畸形），其特征为近节指间关节（PIP）病理性弯曲和远节指间关节（DIP）过度伸展。目前，这种畸形尚无标准的治疗指南。本研究旨在报告手术矫正慢性纽扣畸形的临床结果。
这是一项回顾性病例系列研究，于 2010 年 1 月至 2018 年 12 月进行，仅纳入 13 例创伤性慢性畸形患者。在切除延长的疤痕组织后，采用环形缝线技术直接进行解剖端对端修复，并使用附加缝线锚钉增强。术前和术后均评估总主动活动度，并通过电话调查收集患者的满意度评分。
所有患者均表现为 Burton Ⅰ期畸形，定义为关节柔韧且可被动矫正。PIP 关节的初始平均伸展滞后（43.5°）在末次随访时平均改善了 21.9°（<0.001）。DIP 关节的平均过伸为 19.2°，改善了 0.8°的屈曲挛缩（<0.001）。平均总主动活动度为 220.4°（范围 160°-260°）。根据 Souter 的标准，69.2%（9/13）的患者结果良好。仅有 1 例患者报告结果一般，23.1%（3/13）报告结果较差。Strickland 公式评分平均为 70 分（范围 28.6-97.1）。总共有 10 例（77%）患者结果优秀或良好。在通过电话联系的 10 例患者中，2 例非常满意，3 例满意，3 例一般，1 例较差，1 例非常差。3 例患者在活动度锻炼过程中出现畸形复发，其中 1 例患者接受了翻修手术。1 例患者出现 PIP 关节屈曲受限，2 例患者在末次随访时出现 DIP 关节屈曲受限。
在慢性纽扣畸形中，使用锚钉缝线增强的中央束重建可以作为一种易于应用的手术选择，77%的病例可获得良好至优秀的结果。在手术前应讨论残留伸展滞后和畸形复发的风险。
