Orthopedics. 2022 Jan-Feb;45(1):e53-e56. doi: 10.3928/01477447-20211101-02. Epub 2021 Nov 8.
Arthrodesis and prosthetic arthroplasty have been used to treat severe proximal interphalangeal (PIP) joint arthritis. Silicone implant arthroplasty is an established treatment for rheumatoid arthritis (RA) of the fingers. However, few studies have reported the application of silicone implant arthroplasty for the treatment of severe ankylosis of the PIP joint in RA patients. The authors report, for the first time, the case of a 46-year-old woman who presented with severe bony ankylosis of the right fourth and fifth PIP joints at greater than 90° of flexion. Proximal interphalangeal silicone arthroplasty in combination with reconstruction of the extensor mechanism was successfully performed in the affected joints. Four years after surgery, active flexion of the fourth and fifth PIP joints was 55° and 75°, respectively, with an extensor lag of only 5° without pain and joint instability. Proper repair of the extensor mechanism with shortening of the central slips and mobilization of the lateral bands dorsally was most important in maintaining the extended position of the PIP joints. Proximal interphalangeal silicone arthroplasty with intensive reconstruction of the extensor mechanism could become a potential treatment option to maintain joint mobility even in severe ankylosis of the PIP joints in RA patients. [. 2022;45(1):e53-e56.].
关节融合术和假体关节置换术已被用于治疗严重的近指间（PIP）关节关节炎。硅酮植入物关节置换术是治疗手指类风湿关节炎（RA）的一种成熟治疗方法。然而，很少有研究报道硅酮植入物关节置换术在治疗 RA 患者 PIP 关节严重强直方面的应用。作者首次报道了 1 例 46 岁女性，其右侧第 4、5 个 PIP 关节出现大于 90°屈曲的严重骨性强直。在受累关节成功进行了近端指间硅酮关节置换术联合伸肌机制重建。术后 4 年，第 4、5 个 PIP 关节的主动屈曲分别为 55°和 75°，仅有 5°的伸肌滞后，无疼痛和关节不稳定。通过缩短中央束并将侧束向背侧活动，适当修复伸肌机制对于维持 PIP 关节的伸直位置至关重要。对于 RA 患者 PIP 关节严重强直，近端指间硅酮关节置换术联合强化伸肌机制重建可能成为维持关节活动度的潜在治疗选择。[. 2022;45(1):e53-e56.].
