Koniuch M P, Peimer C A, VanGorder T, Moncada A
Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, Mich.
J Hand Surg Am. 1987 Sep;12(5 Pt 1):750-7. doi: 10.1016/s0363-5023(87)80062-x.
Closed crush injuries from direct blows to the dorsum of the hand may produce significant metacarpophalangeal (MCP) joint symptoms or dysfunction. We have treated 11 patients who had chronic pain and swelling, but without extensor tendon subluxation, for an average of 7.4 months. Only two responded to nonoperative treatment. The nine who had exploratory surgery had a consistent anatomic lesion that consisted of a partial, arcuate tear of the sagittal fibers. All the patients improved postoperatively. Cadaver dissections of the dorsal MCP tendon mechanism in 11 fresh specimens (44 MCP joints) demonstrated that neither partial nor complete transection of the ulnar sagittal fibers produces radial dislocation of extensor tendons. Radial sagittal fiber transections frequently produced ulnar tendon dislocation. Patients who have closed impact injuries of the MCP joints and present with longstanding pain, swelling, and limited mobility without extensor tendon migration may have sustained unrecognized partial ulnar sagittal fiber disruption. Repair of the partial sagittal fiber tear and exploration of the MCP joint is indicated.
手部背侧受到直接打击造成的闭合性挤压伤可能会导致显著的掌指（MCP）关节症状或功能障碍。我们治疗了11例患有慢性疼痛和肿胀但无伸肌腱半脱位的患者，平均病程为7.4个月。只有2例对非手术治疗有反应。接受探查手术的9例患者有一致的解剖学病变，表现为矢状纤维的部分弧形撕裂。所有患者术后均有改善。对11个新鲜标本（44个MCP关节）的MCP背侧肌腱结构进行尸体解剖表明，尺侧矢状纤维的部分或完全横断均不会导致伸肌腱桡侧脱位。桡侧矢状纤维横断经常导致尺侧肌腱脱位。患有MCP关节闭合性撞击伤且伴有长期疼痛、肿胀和活动受限但无伸肌腱移位的患者，可能存在未被识别的尺侧矢状纤维部分断裂。建议修复部分矢状纤维撕裂并探查MCP关节。
