Iselin F, Revol M
Unité Assistance Mains Nanterre, Hôpital de la Maison de Nanterre.
Ann Chir Main. 1983;2(2):143-53. doi: 10.1016/s0753-9053(83)80093-3.
A fixed post-traumatic flexion contracture of a finger is usually secondary to multiple previous operations. We have observed that a former flexor tendon laceration is not constant and is missing in 18% of our cases. The flexor tendons are, nevertheless, always involved in the contracture. A volar skin contracture was present in all cases, but only in half of them was noted a retraction of the volar components of the PIP joint. This articular involvement has no statistical correlation with the time elapsed from the onset of the contracture. We have reviewed 33 cases of post-traumatic flexions contractures of the digits all secondary to volar trauma. In every case there was at least a flexor tendon adhesion and skin contracture. They have all been submitted to both objective and statistical analysis. Results have been evaluated by comparison between the normal functional range of motion for each digit and the actual post-operative active range of motion. On the basis of our study we conclude that the age of the patient is an important prognostic factor. We obtained 75% satisfactory results in patients younger than 27 years, but only 22% in the older group. Good results are more easily obtained in radial (65%) than ulnar digits (31%). While the authors rated 39% of the results bad, half of the patients in this group were satisfied with the result. A volar PIP joint release has been necessary in half of the cases with no significant secondary joint stiffness. A skin flap is necessary to cover the cutaneous defect secondary to the release. There is no statistically significant advantage to cross finger flaps. Therefore we feel that local flaps are indicated except in the cases where local scar tissues would not make it, feasible. The prognosis is independent of the number of previous operations and of associated nerve lesions. Therefore amputation is not the only solution for a multi-operated finger fixed in flexion.
手指固定性创伤后屈曲挛缩通常继发于多次既往手术。我们观察到，既往屈肌腱撕裂并非恒定存在，在我们的病例中有18%未出现。然而，屈肌腱总是参与到挛缩中。所有病例均存在掌侧皮肤挛缩，但只有一半病例观察到近端指间关节（PIP）掌侧结构的回缩。这种关节受累与挛缩开始后的时间间隔无统计学相关性。我们回顾了33例手指创伤后屈曲挛缩病例，均继发于掌侧创伤。每例病例至少存在屈肌腱粘连和皮肤挛缩。所有病例均接受了客观和统计学分析。通过比较每个手指的正常功能活动范围与术后实际主动活动范围来评估结果。基于我们的研究，我们得出结论，患者年龄是一个重要的预后因素。我们在27岁以下患者中获得了75%的满意结果，但在年龄较大组中仅为22%。桡侧手指（65%）比尺侧手指（31%）更容易获得良好结果。虽然作者将39%的结果评为差，但该组中有一半患者对结果满意。一半病例需要进行掌侧PIP关节松解，且未出现明显的继发性关节僵硬。需要皮瓣来覆盖松解术后的皮肤缺损。交叉手指皮瓣并无统计学上的显著优势。因此，我们认为除了局部瘢痕组织不允许的情况外，应采用局部皮瓣。预后与既往手术次数和相关神经损伤无关。因此，对于固定于屈曲位的多次手术手指，截肢并非唯一的解决方案。
