Jones N F, Imbriglia J E, Steen V D, Medsger T A
J Hand Surg Am. 1987 May;12(3):391-400. doi: 10.1016/s0363-5023(87)80012-6.
The role of hand surgery in systemic sclerosis (scleroderma) has been documented infrequently. Out of a series of 813 consecutive patients with scleroderma, 31 have had one or more surgical procedures on their involved hands--a total of 52 operations. Raynaud's phenomenon and digital tip ulcerations have been controlled medically by vasodilators and meticulous local wound care. Most digital ulcerations progressing to frank gangrene have been allowed to autoamputate to maximize the length of the salvaged finger, but 23 digital amputations have been performed when conservative measures failed. Digital sympathectomy and microsurgical revascularization have produced relief of symptoms in several patients. Severe flexion contractures of the proximal interphalangeal (PIP) joints, with secondary hyperextension of the metacarpophalangeal (MP) joints, have been effectively treated by arthrodesis of the PIP joints in 44 to 55 degrees of flexion. This has allowed both improved hand function and primary healing of dorsal ulcers in 53 PIP joints in 12 patients.
手部外科手术在系统性硬化症（硬皮病）中的作用鲜有文献记载。在连续的813例硬皮病患者中，有31例患者对受累手部进行了一次或多次外科手术——总共进行了52次手术。雷诺现象和指尖溃疡已通过血管扩张剂和精心的局部伤口护理得到了药物控制。大多数发展为明显坏疽的手指溃疡已任其自行截肢，以最大限度地保留手指长度，但在保守治疗失败时进行了23次手指截肢手术。手指交感神经切除术和显微外科血管重建术已使数名患者的症状得到缓解。近端指间（PIP）关节严重屈曲挛缩并伴有掌指（MP）关节继发性过度伸展，通过将PIP关节固定在44至55度屈曲位进行关节融合术得到了有效治疗。这使得12例患者的53个PIP关节的手部功能得到改善，背部溃疡实现一期愈合。
