Division of Orthopedic Surgery Department of Regenerative and Transplant Medicine, Niigata University, Graduate School of Medicine and Dental Sciences, Niigata, Japan.
Department of Rheumatology, Niigata Rheumatic Center, Shibata, Japan.
Mod Rheumatol. 2022 Apr 18;32(3):541-545. doi: 10.1093/mr/roab015.
To investigate the outcomes of the modified Thompson-Littler (m-TL) method, a corrective surgical method utilising a dynamic tenodesis, in patients with rheumatoid swan-neck deformity.
Twenty-seven fingers in 10 patients with rheumatoid arthritis (RA) underwent surgical correction. The mean age at the time of surgery was 60.3 (45-77) years, the mean duration of RA was 19.3 (4-34) years, and the mean postoperative follow-up period was 2.4 (0.5-6) years.
The deformity was corrected and the proximal interphalangeal (PIP) joint pain disappeared in all operated fingers. The mean pinch power between the thumb and the operated finger increased. The active extension decreased, the active flexion increased, and the total arc of motion decreased. Comparing the range of motion by Nalebuff's type classification, the postoperative arc of motion decreased as the type advanced.
The m-TL method provided a favourable outcome in cases of Type ≤III rheumatoid swan-neck deformity without severe joint deterioration at the PIP joint. Aesthetic and functional improvements were observed and the patients were satisfied with the operation.
探讨改良 Thompson-Littler（m-TL）法的治疗效果，该方法采用动态肌腱固定术矫正类风湿天鹅颈畸形。
10 例类风湿关节炎（RA）患者的 27 个手指接受了手术矫正。手术时的平均年龄为 60.3（45-77）岁，RA 的平均病程为 19.3（4-34）年，平均术后随访时间为 2.4（0.5-6）年。
所有手术手指的畸形均得到矫正，近侧指间关节（PIP）疼痛消失。拇指与手术手指之间的平均捏力增加。主动伸展减少，主动屈曲增加，总活动度减少。通过 Nalebuff 分型比较关节活动度，术后关节活动度随类型进展而减少。
m-TL 方法对于 PIP 关节无严重关节退变的≤III 型类风湿天鹅颈畸形患者，提供了良好的治疗效果。观察到了美观和功能的改善，患者对手术结果满意。
