Pearl R M, Hentz V R
Division of Hand Surgery, Stanford University Hospital, Calif.
Plast Reconstr Surg. 1993 Sep;92(3):507-10. doi: 10.1097/00006534-199309000-00020.
Thirty percent of patients with rheumatoid arthritis develop ulnar drift. Although numerous operations have been described, recurrence of the deformity is frequent. We recommend use of the extensor digiti minimi tendon transfer to prevent recurrent ulnar deviation. The tendon insertion is moved from a dorsal location to a dorsal-radial position. In this new location, the tendon produces both extension and radial deviation. Moreover, this transfer is maximally effective in extension when ulnar drift is greatest. We have used this transfer 28 times during the past 6 years. In evaluating patients more than 1 year after surgery, metacarpal phalangeal joint extension averaged 52 degrees and there was no evidence of recurrent ulnar drift of the little finger. The only problem was slight hyperextension of less than 5 degrees in approximately half of the patients. However, in no patient was this functionally a problem. We recommend the use of this tendon transfer in all patients with ulnar drift undergoing metacarpal phalangeal joint replacement for rheumatoid arthritis.
30%的类风湿性关节炎患者会出现尺侧偏移。尽管已有多种手术方法被描述，但畸形复发很常见。我们建议使用小指伸肌腱转位术来预防复发性尺侧偏斜。肌腱附着点从背侧位置移至背桡侧位置。在这个新位置，肌腱可产生伸展和桡侧偏斜。此外，当尺侧偏移最大时，这种转位术在伸展方面效果最佳。在过去6年中，我们已进行了28次这种转位术。在对术后1年以上的患者进行评估时，掌指关节伸展平均为52度，且没有证据表明小指出现复发性尺侧偏移。唯一的问题是约一半的患者存在不到5度的轻度过伸。然而，在任何患者中，这在功能上都不是问题。我们建议在所有因类风湿性关节炎接受掌指关节置换且有尺侧偏移的患者中使用这种肌腱转位术。
