Glicenstein J, Haddad R, Guero S
Urgences Mains Enfants, Hôpital Robert Debré, Paris.
Ann Chir Main Memb Super. 1995;14(6):264-71. doi: 10.1016/s0753-9053(05)80405-3.
Almost all anatomical structures of the hand have been held responsible for non-traumatic, non-paralytic flexion deformity of the proximal interphalangeal joint. Together with Millesi and Flatt, we define camptodactyly as a disorder of flexor-extensor equilibrium in the PIP. This definition determined our therapeutic approach. 59 patients with one or several fingers affected by camptodactyly were followed between 1975 and 1989. In 3 cases, the anomaly was associated with another malformation of the hand and 56 cases, it was isolated. 11 children did not receive any active treatment, but were followed and manipulated. 17 (27 fingers) were treated by static or dynamic splints. 31 (43 fingers) were operated according to the following technique: total anterior tenoarthrolysis leading to recession of the flexor apparatus and lengthening of the skin on the palmar surface of the first phalanx by a rotation flap. This operation was preceded and followed by application of a dynamic extension splint onto the operated finger. Of the 20 fingers treated by manipulations and reviewed, 11 had improved, 7 were stable and 2 had deteriorated. Of the 24 fingers treated by splints and reviewed, 14 had improved, 5 were stable and 5 had deteriorated. Of the 30 fingers operated and reviewed, 30 had improved, 7 were stable and 2 had deteriorated. Although recent anatomical studies tend to indicate that anomalies of the lumbrical muscles are frequent in operated camptodactyly, these studies do not take into account the numerous anomalies of these muscles observed in the general population. The therapeutic conclusion resulting from these studies are also unconvincing. The technique which we propose cannot be applied to every case. The milder forms only require orthopaedic treatment. C camptodactyly in adolescents or adults with joint blocking are only slightly improved by surgery and only require corrective osteotomy. In all other cases, especially in young children, anterior tenoarthrolysis of the finger with cutaneous elongation allows reduction or correction of the deformity.
几乎手部的所有解剖结构都被认为与近端指间关节的非创伤性、非麻痹性屈曲畸形有关。我们与米莱西和弗拉特一起，将先天性屈曲指定义为近端指间关节屈伸平衡的一种紊乱。这一定义决定了我们的治疗方法。1975年至1989年间，对59例一个或多个手指患有先天性屈曲指的患者进行了随访。其中3例该异常与手部的另一种畸形相关，56例为孤立性病变。11名儿童未接受任何积极治疗，但接受了随访和手法治疗。17例（27指）采用静态或动态夹板治疗。31例（43指）根据以下技术进行手术：完全前路腱关节松解术，导致屈肌装置退缩，并通过旋转皮瓣延长第一指骨掌面的皮肤。该手术前后均在手术手指上应用动态伸展夹板。在接受手法治疗并接受复查的20指中，11指有所改善，7指情况稳定，2指恶化。在接受夹板治疗并接受复查的24指中，14指有所改善，5指情况稳定，5指恶化。在接受手术并接受复查的30指中，30指有所改善，7指情况稳定，2指恶化。尽管最近的解剖学研究倾向于表明，在接受手术治疗的先天性屈曲指中，蚓状肌异常很常见，但这些研究没有考虑到在普通人群中观察到的这些肌肉的众多异常情况。这些研究得出的治疗结论也缺乏说服力。我们提出的技术并非适用于所有病例。较轻的病例仅需骨科治疗。青少年或成人中伴有关节阻滞的先天性屈曲指通过手术仅略有改善，仅需进行矫正截骨术。在所有其他情况下，尤其是在幼儿中，手指前路腱关节松解术并延长皮肤可减轻或矫正畸形。
