Kasabian A, McCarthy J, Karp N
Institute of Reconstructive Plastic Surgery, NYU Medical Center, New York, NY, USA.
Ann Plast Surg. 1998 Apr;40(4):378-81. doi: 10.1097/00000637-199804000-00010.
Proximal interphalangeal (PIP) joint contractures are common complications in hand injuries and conditions such as Dupuytren's contracture. Conventional treatment such as splinting and serial casting may result in inadequate improvement. Operative release of the contracture may be complicated by neurovascular overstretch with injury to the digital nerves or vascular compromise. Gradual distraction of the contracted joint may prevent this neurovascular injury. The multiplanar distracter was designed for three-dimensional distraction of the mandible. Distraction may be obtained in the X, Y, or Z planes. With this device, the angular relationship between two planes may be altered. A 22-year-old male with a PIP joint contraction following replantation failed conventional treatment for release. With the use of a multiplanar distracter, the flexion contraction was reduced from 95 degrees to a more functional 30 degrees using gradual angular distraction. The angle between the proximal and middle phalanges were gradually changed using the ability of the distracter to change the angular relationship in the X-Y plane. At 3 and 6 months postdistraction, the patient has maintained his 30-degree flexion angle. The multiplanar distracter is a simple technique that may be useful for the treatment of PIP joint contractures that fail conventional therapy.
近端指间（PIP）关节挛缩是手部损伤以及诸如杜普伊特伦挛缩症等病症中的常见并发症。诸如夹板固定和连续石膏固定等传统治疗方法可能改善效果不佳。挛缩的手术松解可能因神经血管过度拉伸导致指神经损伤或血管受损而变得复杂。挛缩关节的逐渐牵张或许可以避免这种神经血管损伤。多平面牵张器是为下颌骨的三维牵张而设计的。可以在X、Y或Z平面上实现牵张。使用该装置，可以改变两个平面之间的角度关系。一名22岁男性在再植后出现PIP关节挛缩，常规松解治疗失败。使用多平面牵张器，通过逐渐的角度牵张，将屈曲挛缩从95度减少到更具功能的30度。利用牵张器改变X - Y平面角度关系的能力，逐渐改变近端和中间指骨之间的角度。牵张后3个月和6个月时，患者保持了30度的屈曲角度。多平面牵张器是一种简单的技术，可能有助于治疗常规治疗失败的PIP关节挛缩。
