Abstract：
Management of recurrent Dupuytren\'s disease of the little finger is challenging. Various treatment modalities have been proposed: external fixation, local skin flap, dermofasciectomy, or even amputation. An alternative surgical technique was introduced by Honecker et al. in 2016 and refined by Raimbeau et al. in 2019, consisting in resection of the middle phalanx and shortening arthrodesis. We modified the technique by combining arthrodesis with a limited fasciectomy of the abductor and/or pretendinous cord in the fifth ray to improve cosmetic and functional outcomes.
Patients with severe recurrent Dupuytren\'s disease of the little finger (Tubiana stage III/IV) were treated with proximodistal interphalangeal arthrodesis, combined with limited fasciectomy. Range of motion was assessed preoperatively and postoperatively. QuickDASH and a VAS were assessed to determine overall function and pain respectively. Radiographic evaluation was made at 6 and 12 weeks postoperatively.
Thirteen patients were eligible for inclusion. Mean age was 69 years (range 49-87). Radiographic consolidation was obtained at a mean 58 days (range 27-97). Full extension of the metacarpophalangeal joint was achieved in 11 patients and full adduction in 12. Mean active flexion was 94° (range 90-100). QuickDASH scores decreased from 18 to 12 after surgery. Pain scores were low and unchanged.
By combining proximodistal interphalangeal arthrodesis with limited fasciectomy through a volar approach, finger extension improved, and fixed abduction was also treated. The combined volar and dorsal approach did not induce vascular impairment or other complications.
Patients with severe recurrent Dupuytren\'s disease of the little finger (Tubiana stage III/IV) were treated with proximodistal interphalangeal arthrodesis, combined with limited fasciectomy. Range of motion was assessed preoperatively and postoperatively. QuickDASH and a VAS were assessed to determine overall function and pain respectively. Radiographic evaluation was made at 6 and 12 weeks postoperatively.
Thirteen patients were eligible for inclusion. Mean age was 69 years (range 49-87). Radiographic consolidation was obtained at a mean 58 days (range 27-97). Full extension of the metacarpophalangeal joint was achieved in 11 patients and full adduction in 12. Mean active flexion was 94° (range 90-100). QuickDASH scores decreased from 18 to 12 after surgery. Pain scores were low and unchanged.
By combining proximodistal interphalangeal arthrodesis with limited fasciectomy through a volar approach, finger extension improved, and fixed abduction was also treated. The combined volar and dorsal approach did not induce vascular impairment or other complications.
摘要：
目的：复发性小指Dupuytren病的治疗具有挑战性。已经提出了各种治疗方式：外固定，局部皮瓣,皮肤筋膜切除术,甚至截肢.Honecker等人介绍了另一种手术技术。2016年，由Raimbeau等人完善。2019年，包括切除中指骨和缩短关节固定术。我们通过将关节固定术与第五射线中的外展肌和/或腱前索的有限筋膜切除术相结合来改进该技术，以改善美容和功能效果。
方法：对患有严重复发性小指Dupuytren病（TubianaIII/IV期）的患者进行近端远端指间关节固定术治疗，结合有限的筋膜切除术。术前和术后评估活动范围。分别评估QuickDASH和VAS以确定总体功能和疼痛。术后6周和12周进行影像学评估。
结果：13例患者符合入选条件。平均年龄为69岁（范围49-87）。在平均58天（范围27-97）获得了影像学巩固。11例患者实现了掌指关节的完全伸展，12例实现了完全内收。平均主动屈曲为94°（范围90-100）。手术后QuickDASH评分从18降至12。疼痛评分较低且无变化。
结论：通过掌侧入路结合近端远端指间关节固定术和有限的筋膜切除术，手指延伸改进，固定绑架也得到了治疗。掌侧和背侧联合入路未引起血管损伤或其他并发症。
方法：对患有严重复发性小指Dupuytren病（TubianaIII/IV期）的患者进行近端远端指间关节固定术治疗，结合有限的筋膜切除术。术前和术后评估活动范围。分别评估QuickDASH和VAS以确定总体功能和疼痛。术后6周和12周进行影像学评估。
结果：13例患者符合入选条件。平均年龄为69岁（范围49-87）。在平均58天（范围27-97）获得了影像学巩固。11例患者实现了掌指关节的完全伸展，12例实现了完全内收。平均主动屈曲为94°（范围90-100）。手术后QuickDASH评分从18降至12。疼痛评分较低且无变化。
结论：通过掌侧入路结合近端远端指间关节固定术和有限的筋膜切除术，手指延伸改进，固定绑架也得到了治疗。掌侧和背侧联合入路未引起血管损伤或其他并发症。
