The Curtis National Hand Center, Baltimore, MD.
The Curtis National Hand Center, Baltimore, MD.
J Hand Surg Am. 2023 Jul;48(7):737.e1-737.e10. doi: 10.1016/j.jhsa.2022.01.023. Epub 2022 Mar 8.
We investigated closed passive manipulation as an alternative to surgery for certain proximal interphalangeal (PIP) joint extension contractures.
We retrospectively reviewed all patients with PIP joint extension contractures treated with passive manipulation at our institution between 2015 and 2019. The included patients were a minimum of 12 weeks from their initial injury/surgery (median 179 days; interquartile range: 130-228 days), had plateaued with therapy, and underwent a 1-time passive manipulation. All included fingers had congruent PIP joints and no indwelling hardware that could have had direct adhesions. Most (80%) patients had a direct injury to the finger ray(s) that led to the contractures. Most (75%) patients had the manipulation performed under local anesthesia in the office. Available measures of passive range of motion (PROM) and active range of motion (AROM) immediately, within 6 weeks, between 6 and 12 weeks, and at >12 weeks after the manipulation were recorded.
Twenty-eight patients and 46 digits met the criteria. The median PIP joint PROM improved from 50° to 90° immediately following the manipulation. The median PROM values within 6 weeks, between 6 and 12 weeks, and at >12 weeks following manipulation were 80°, 85°, and 85°, respectively. The median AROM immediately after the manipulation improved from 40° to 90°, and the median AROM values within 6 weeks, between 6 and 12 weeks, and at >12 weeks were 70°, 50°, and 60°, respectively. None of the patients experienced worsening of PIP joint range of motion. One patient who had 4 fingers manipulated had a 45° distal interphalangeal joint extension lag for one of the fingers after the manipulation. Eight fingers underwent later flexor tenolysis or reconstruction to improve AROM after the gains in PROM via manipulation were maintained.
Passive manipulation is an alternative to surgical release for select PIP joint extension contractures.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
我们研究了闭合性被动手法作为治疗某些近节指间关节（PIP）伸展挛缩的替代方法。
我们回顾性分析了 2015 年至 2019 年在我院接受被动手法治疗的所有 PIP 关节伸展挛缩患者。纳入的患者从初次损伤/手术后至少 12 周（中位数 179 天；四分位间距：130-228 天），经治疗后已进入平台期，且接受了 1 次被动手法治疗。所有纳入的手指 PIP 关节均一致，且无可能直接粘连的内置硬件。大多数（80%）患者手指射线（s）直接受伤，导致挛缩。大多数（75%）患者在局麻下于诊室接受手法治疗。记录手法治疗即刻、6 周内、6-12 周和>12 周后的被动关节活动度（PROM）和主动关节活动度（AROM）的测量值。
28 名患者和 46 个手指符合纳入标准。PIP 关节 PROM 中位数从手法治疗后即刻的 50°增加至 90°。6 周内、6-12 周和>12 周时 PROM 的中位数分别为 80°、85°和 85°。手法治疗后即刻 AROM 中位数从 40°增加至 90°，6 周内、6-12 周和>12 周时 AROM 的中位数分别为 70°、50°和 60°。无患者出现 PIP 关节活动度恶化。1 名接受 4 个手指手法治疗的患者，其中 1 个手指在治疗后出现 45°远侧指间关节伸展滞后。8 个手指在 PROM 经手法治疗改善后，行屈肌腱松解或重建以改善 AROM，且 PROM 的改善得以维持。
闭合性被动手法是治疗特定 PIP 关节伸展挛缩的手术松解的替代方法。
研究类型/证据水平：治疗性 IV 级。
