Ward W A, Van Moore A
Miller Orthopaedic Clinic, Department of Radiology, Charlotte, NC 28203, USA.
J Hand Surg Am. 1995 Sep;20(5):868-72. doi: 10.1016/s0363-5023(05)80446-0.
Twelve patients (15 hands) with documented scleroderma and chronic nonhealing digital ulcers were followed for their response to nonoperative and operative treatment. The patients were initially managed with nifedipine, biofeedback, digital xylocaine blockade, and silver sulfadiazine topical ointment and cessation of all vasoconstrictive agents. Ulcerations healed in 6 of 15 hands and remained healed at a 2-year follow-up examination. The remaining nine hands in seven patients failed nonoperative treatment and underwent a palmar digital sympathectomy. These chronic digital ulcerations healed within 6 weeks after surgery. After a 26- to 64-month follow-up period, six of the nine hands remained free of all digital ulcerations. Two patients (three hands) had partial recurrence of the ulceration. Digital sympathectomy can be an effective procedure for treating nonhealing digital ulcers in scleroderma patients after nonoperative treatment has failed. Significant vaso-occlusive disease is likely to be present in these patients, as demonstrated by arteriography. Our initial approach is cessation of all vasoconstricting agents, nifedipine biofeedback, and local antibiotic ointment. Wrist blocks with xylocaine and marcaine are offered if these modalities fail. If these methods do not result in healing of the ulcer within 12 weeks, then digital sympathectomy is considered.
对12例（15只手）确诊为硬皮病且患有慢性不愈合指端溃疡的患者进行了非手术和手术治疗反应的随访。患者最初接受硝苯地平、生物反馈、指端利多卡因阻滞、磺胺嘧啶银外用软膏治疗，并停用所有血管收缩剂。15只手中有6只手的溃疡愈合，在2年的随访检查中仍保持愈合状态。其余7例患者的9只手非手术治疗失败，接受了掌部指端交感神经切除术。这些慢性指端溃疡在术后6周内愈合。经过26至64个月的随访期，9只手中有6只手未再出现任何指端溃疡。2例患者（3只手）溃疡部分复发。对于非手术治疗失败的硬皮病患者，指端交感神经切除术可能是治疗不愈合指端溃疡的有效方法。血管造影显示，这些患者可能存在严重的血管闭塞性疾病。我们最初的治疗方法是停用所有血管收缩剂、使用硝苯地平进行生物反馈治疗以及局部使用抗生素软膏。如果这些方法无效，则采用利多卡因和布比卡因腕部阻滞。如果这些方法在12周内未能使溃疡愈合，则考虑进行指端交感神经切除术。
