O'Brien E T
Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, USA.
Clin Plast Surg. 1996 Jul;23(3):407-20.
Each surgical procedure available for the rheumatoid hand has a score card. The most indicated and necessary procedures include: extensor tenosynovectomy and Darrach for the impending or already ruptured extensor tendons; flexor tenosynovectomy and carpal tunnel release for the patient with impaired median nerve function; stabilization of the deformed unstable thumb with MP or IP arthrodesis; and flexor tenosynovectomy in the palm and finger of a motivated patient with significant disparity between active and passive motion. Relative indications for surgery include arthrodesis for the unstable wrist; MP arthroplasty for the fixed MP volar and ulnar subluxation with inability to open the hand; synovectomy for the occasional patient with painful boggy synovitis of the MP or PIP joint; and reconstruction of the fixed swan neck deformity with relatively good PIP joints. Both MP and PIP joints can and should be operated on at the same time. Extensive wrist surgery, that is, tenosynovectomy and Darrach or arthrodesis, should not be performed at the same time as MP arthroplasty. Try to do the "winner operations" first.
每种适用于类风湿性手部的外科手术都有一份评分卡。最具指征性且必要的手术包括：对于即将断裂或已断裂的伸肌腱进行伸肌滑膜切除术和Darrach手术；对于正中神经功能受损的患者进行屈肌滑膜切除术和腕管松解术；通过掌指关节（MP）或指间关节（IP）融合术来稳定畸形不稳定的拇指；对于主动和被动活动存在明显差异且积极配合的患者，在手掌和手指进行屈肌滑膜切除术。手术的相对指征包括：对不稳定的腕关节进行融合术；对固定性掌指关节掌侧和尺侧半脱位且无法张开手的情况进行掌指关节成形术；对偶尔出现掌指关节或近端指间关节（PIP）疼痛性肿胀滑膜炎的患者进行滑膜切除术；以及对近端指间关节相对良好的固定性鹅颈畸形进行重建。掌指关节和近端指间关节都可以且应该同时进行手术。广泛的腕部手术，即滑膜切除术和Darrach手术或融合术，不应与掌指关节成形术同时进行。尽量先进行“优势手术”。
