这是一个由来已久的教导,除非非手术治疗失败,如连续夹板和手部治疗,并且有一个60°的近端指间关节(PIPJ)挛缩;最近的系统评价反映了这种持续的方法,一些论文主张采用较小程度的挛缩进行干预。
为了评估早期掌上屈肌(FDS)是否释放,其次是温和的被动操纵(GPM),将积极纠正严重的“先天性”,如果在比平时更早的年龄进行,从而避免了在已确定的青少年病例中所需的更积极的手术方法。
描述了手术技术和治疗算法。介绍了一个多中心病例系列;数据分析包括患者人口统计,综合征协会,侧面/数字受影响,发病年龄,programming,转诊和手术时,操作详细信息,术前和术后挛缩和活动范围。
有12名患者(3名男性,9名女性),接受了15次手术,涉及24个数字。患者在转诊后3个月(中位数)进行了手术,中位(范围)PIPJ挛缩(90°(30°-90°)与0°(0°-45°);p<0.001)和运动范围(0°(0°-60°)与90°(50°-95°);p<0.001),术后中位随访2.5年.根据西格特等级,87.5%的数字具有优异/良好的术后结果,12.5%的数字具有公平的结果。
这篇论文专门针对幼儿的攻击性和渐进性坎坷问题。通过这个,我们指的是非手术治疗失败且PIPJ挛缩≥60°的患者,和那些在1年内挛缩增加了30°的人。所有病例都对早期FDS释放和GPM做出了反应,从而纠正PIPJ挛缩。然而,涉及多个数字的案件,不管是不是综合征,以前的手术失败或年龄较大的孩子,需要额外的程序来恢复动态背侧装置和主动延伸。
It is a long-established teaching to avoid operating on camptodactyly unless there is a failure of non-operative treatment, such as serial splinting and hand therapy, and there is an established proximal interphalangeal joint (PIPJ) contracture of 60°; a recent systematic review reflects this continuing approach, with some papers advocating intervention with a lesser degree of contracture.
To evaluate whether early flexor digitorum superficialis (FDS) release, followed by gentle passive manipulation (GPM), will correct severe \'congenital\' camptodactyly, if undertaken at an earlier age than usual, thus avoiding the more aggressive surgical approach required in the established adolescent cases.
The surgical technique and treatment algorithm are described. A multi-centre case series is presented; data analysis included patient demographics, syndromic association, side/digit affected, ages at onset, progression, referral and at surgery, operation details, pre- and post-operative contracture and range of motion.
There were 12 patients (3 males, 9 females) who underwent 15 operations for 24 involved digits. Patients had surgery by 3 months (median) post-referral, and there was a significant improvement in median (range) PIPJ contracture (90°(30°-90°) vs. 0°(0°-45°); p<0.001) and range of motion (0°(0°-60°) vs. 90°(50°-95°); p<0.001), at a median post-operative follow-up of 2.5 years. According to the Siegert grade, 87.5% of digits had excellent/good post-operative outcomes and 12.5% had fair outcomes.
This paper specifically addresses the problem of aggressive and progressive camptodactyly in the young child. By this, we mean patients who have failed non-operative treatment and have PIPJ contractures ≥60°, and those whose contractures have increased by 30° within 1 year. All cases responded to early FDS release and GPM, hence correcting the PIPJ contracture. However, cases with multiple digital involvement, whether syndromic or not, and failed previous surgery or the older child, required additional procedures to restore a dynamic dorsal apparatus and active extension.