Department of Orthopaedics and Traumatology, Baskent University Alanya Research and Practice Center, Saray Mahallesi Yunus Emre Caddesi No:1, 07400, Alanya, Antalya, Turkey.
BMC Musculoskelet Disord. 2022 Jul 22;23(1):697. doi: 10.1186/s12891-022-05605-1.
Finger collateral ligament injuries are common, and conservative treatment usually works well. However, complete ruptures that lead to instability could cause painful disability. This study presents our clinical experience and a qualitative functional evaluation following the surgical repair of the thumb and proximal interphalangeal (PIP) joint collateral ligament ruptures.
Thirty-five patients (22 men and 13 women), diagnosed via a physical examination and magnetic resonance imaging (MRI) with a total collateral ligament rupture in the metacarpophalangeal thumb (16) and PIP joints of the lesser digits (19) and treated surgically, were evaluated retrospectively. The limited range of motion; functional score by Saetta; disabilities of the arm, shoulder, and hand (DASH) score; pre- and post-operative pain, deformity level; and post-operative ability to grip keys, buttons, and jars were measured. The significance of the change between the pre and post-operative visual analog scale for pain (VAS) scores were evaluated using the Wilcoxon signed-rank test. The difference between the lesser digits and thumb groups by patient age was evaluated using the Mann-Whitney-U test. All data, such as the mean, range, and standard deviation, were calculated using SPSS.
The mean pre- and post-operative VAS scores were 4.8 (from 3 to 7) and 0.91 (0 to 4), respectively. The mean post-operative limitation in the range of motion was 9.78° (s = 14.47) for lesser digits and 6.87° (s = 12.29) for the thumb. According to Seatta et al., the final functional score was 62.5% excellent, 25% good, and 12.5% moderate for the thumb and 84.2% excellent, 10.5% good, and 5.3% poor for the lesser digits. The mean post-operative DASH score was 13.55 (SD: 8.77) for lesser digits and 14.22 (SD: 8.9) for the thumb. The mean contralateral (healthy) hand DASH score was 0.75 (SD: 1.05) for lesser digits and 0.75 (SD: 1.05) for the thumb. For the thumb and lesser digits, the z-scores were - 3.55 and - 3.787, respectively, and the progress of the VAS score was significant (p < 0.05).
After a 40-month follow-up for 35 acute, subacute, and chronic cases, the results suggest that direct and suture-anchor repairs are feasible, painless treatments associated with good finger function.
手指侧副韧带损伤较为常见，通常保守治疗效果良好。然而，完全断裂导致不稳定可能会导致疼痛性残疾。本研究介绍了我们在拇指和近侧指间关节（PIP）侧副韧带完全断裂后的手术修复方面的临床经验和定性功能评估。
对 35 例（22 名男性和 13 名女性）经体格检查和磁共振成像（MRI）诊断为掌指骨拇指（16 例）和小指 PIP 关节（19 例）总侧副韧带完全断裂的患者进行回顾性分析。测量运动范围受限情况、Saetta 功能评分、手臂、肩部和手部残疾（DASH）评分、术前和术后疼痛、畸形程度以及术后握钥匙、按钮和罐子的能力。使用 Wilcoxon 符号秩检验评估术前和术后视觉模拟量表（VAS）疼痛评分变化的显著性。使用 Mann-Whitney-U 检验评估小指组和拇指组之间的患者年龄差异。使用 SPSS 计算所有数据，如平均值、范围和标准差。
拇指的平均术前和术后 VAS 评分分别为 4.8（3 至 7）和 0.91（0 至 4）。小指的平均术后运动范围受限为 9.78°（s=14.47），拇指为 6.87°（s=12.29）。根据 Seatta 等人的评估，拇指的最终功能评分为 62.5%为优秀，25%为良好，12.5%为中等，小指的最终功能评分为 84.2%为优秀，10.5%为良好，5.3%为中等。小指的平均术后 DASH 评分为 13.55（SD：8.77），拇指为 14.22（SD：8.9）。小指和拇指的健侧（健康）手 DASH 评分为 0.75（SD：1.05）。拇指和小指的 z 分数分别为-3.55 和-3.787，VAS 评分的进展具有统计学意义（p<0.05）。
对 35 例急性、亚急性和慢性病例进行 40 个月的随访后，结果表明直接和缝合锚修复是可行的、无痛的治疗方法，可获得良好的手指功能。
