Oda Ryo, Okubo Naoki, Toyama Shogo, Tsuchida Shinji, Takahashi Kenji
Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
J Hand Surg Glob Online. 2025 Aug 14;7(6):100808. doi: 10.1016/j.jhsg.2025.100808. eCollection 2025 Nov.
We investigated the outcomes of an original functional reconstruction procedure for ulnar drift (UD) with extensor tendon subluxation due to rheumatoid arthritis.
From 2018 to 2022, reconstruction was performed in 10 patients (31 fingers), with UD due to rheumatoid arthritis and a minimum of 2-year follow-up. The mean age was 57 years, and the mean follow-up period was 4.5 years. Ulnar drift was assessed using the Fearnley classification and included 17 stage 1 cases and 14 stage 2 fingers. A half-slip tendon was created just above the metacarpal head. An anchor was driven into the center of rotation of the metacarpophalangeal (MCP) joint on the radial side of the metacarpal bone, and the half-slip tendon was sutured and fixed. If limitations were observed in the flexion of the MCP joint, the extensor tendon was step-cut, and the half-slip tendon was fixed via an interlacing suture to the step-cut distal extensor tendon. We investigated the patient's background and range of motion. The Disabilities of the Arm, Shoulder, and Hand questionnaire and the Michigan Hand Outcomes Questionnaire of patient-reported outcome measures were scored as functional outcomes.
At a mean of 54 months after the operation, the average extension in the MCP joint improved from -12° (range: -80° to 28°) before surgery to 1.5° (range: -40° to 20°) at the final follow-up ( < .05), whereas the average flexion had no remarkable change. The average active arc of motion of the operated MCP joint was significantly increased to 95° (range: 60°-120°) compared with 82° (range: 34°-118°) before surgery ( < .05). The Disabilities of the Arm, Shoulder, and Hand questionnaire and the Michigan Hand Outcomes Questionnaire scores improved significantly. No recurrence of UD, such as a decreased Fearnley stage, was documented.
We present good results with no recurrence using a dynamic tenodesis technique as a functional reconstruction for UD with finger extensor tendon subluxation caused by rheumatoid arthritis, with a particular focus on joint preservation via soft tissue reconstruction.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
我们研究了一种针对类风湿性关节炎所致尺侧偏移（UD）伴伸肌腱半脱位的原创功能性重建手术的疗效。
2018年至2022年期间，对10例患者（31根手指）进行了重建手术，这些患者均因类风湿性关节炎出现尺侧偏移，且至少随访2年。平均年龄为57岁，平均随访期为4.5年。采用费恩利分类法评估尺侧偏移情况，其中17例为1期，14根手指为2期。在掌骨头上方制作一条半滑脱肌腱。将锚钉打入掌骨桡侧掌指（MCP）关节的旋转中心，然后将半滑脱肌腱缝合固定。如果观察到MCP关节屈曲受限，则对伸肌腱进行阶梯式切断，并通过交织缝合将半滑脱肌腱固定于阶梯式切断的远端伸肌腱上。我们调查了患者的背景情况和活动范围。采用手臂、肩部和手部功能障碍问卷以及密歇根手部结果问卷对患者报告的结果指标进行评分，以此作为功能结局。
术后平均54个月时，MCP关节的平均伸展角度从术前的-12°（范围：-80°至28°）改善至末次随访时的1.5°（范围：-40°至20°）（P<0.05），而平均屈曲角度无明显变化。与术前的82°（范围：34°至118°）相比，手术治疗的MCP关节的平均主动活动弧度显著增加至95°（范围：60°至120°）（P<0.05）。手臂、肩部和手部功能障碍问卷以及密歇根手部结果问卷的评分显著改善。未记录到尺侧偏移复发情况，如费恩利分期降低。
我们采用动态腱固定技术对类风湿性关节炎所致尺侧偏移伴手指伸肌腱半脱位进行功能性重建，取得了良好效果且无复发，尤其注重通过软组织重建来保留关节。
研究类型/证据水平：治疗性IV级。
