Kang Yong Chiang, Lee Che-Hsiung, Lin Yu-Te
Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore.
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
JPRAS Open. 2025 Mar 21;44:402-410. doi: 10.1016/j.jpra.2025.03.012. eCollection 2025 Jun.
Posttraumatic proximal interphalangeal joint (PIPJ) flexion contracture is a common but difficult problem. Comprehensive literature is sparse, with inconsistent surgical techniques and outcomes. In this study, we describe in detail the volar approach of stepwise release and evaluate the outcomes of using the proximal interphalangeal joint adipofascial flap (PIPJAF) to cover the volar capsule of PIPJ.
In this retrospective cohort study spanning over 12 years, we compared 19 patients with PIPJAF and 16 patients without PIPJAF, with a minimum follow-up of 6 months postoperatively.
In the PIPJAF group, there was significant improvement in active flexion arc (70.8°, SD 18.6°) at 6 months, and at 6 months and later significantly better extension lag angle (20.8°, SD 19.2°), improvement in extensor lag angle (29.2°, SD 15.3°), and improvement ratio (0.62, SD 0.33) were observed.
There is a modest mid-term benefit in using the PIPJAF. We propose integrating the volar approach with PIPJAF in suitable patients with adequate adipofascial tissue on the lateral aspect of the finger.
III - retrospective cohort study.
创伤后近端指间关节（PIPJ）屈曲挛缩是一个常见但棘手的问题。全面的文献资料稀少，手术技术和结果也不一致。在本研究中，我们详细描述了掌侧逐步松解方法，并评估了使用近端指间关节脂肪筋膜瓣（PIPJAF）覆盖PIPJ掌侧关节囊的效果。
在这项为期12年的回顾性队列研究中，我们比较了19例使用PIPJAF的患者和16例未使用PIPJAF的患者，术后随访至少6个月。
在PIPJAF组中，术后6个月时主动屈曲弧有显著改善（70.8°，标准差18.6°），在6个月及以后，伸直滞后角明显更好（20.8°，标准差19.2°），伸肌滞后角有所改善（29.2°，标准差15.3°），改善率为（0.62，标准差0.33）。
使用PIPJAF有一定的中期益处。我们建议在手指外侧有足够脂肪筋膜组织的合适患者中，将掌侧入路与PIPJAF相结合。
III - 回顾性队列研究。
