CAJ | 학술논문

目的研究改良支具固定治疗伤后1个月以上陈旧腱性锤状指的临床效果.方法自2007年11月至2010年1月,对26例陈旧腱性锤状指患者采用改良支具固定.从受伤到接受固定时间为4～14周,平均7周.我们对传统固定支具进行改良,由近指间关节屈曲、远指间关节过伸位固定,改为近指间关节伸直、远指间关节轻度过伸,以增加固定的牢固性.严格固定6周后,去除外固定,开始功能练习,并用夜间支具继续固定4周.结果 26例中,4例失访,22例获得随访,时间为2～6个月,平均3个月.接受治疗的手指均较治疗前有明显的改善.远指间关节伸直角度治疗前平均为-38°(-15°～-70°),治疗后为-2°(0°～-10°).按照Patel评定法评定:优19例,良3例.有3例在固定过程中,由于固定粘带压迫,出现远指间关节一过性疼痛、肿胀;调整支具固定粘带后,症状缓解,能够继续固定.1例去除固定1周后出现15°的屈曲畸形,重新固定4周,获得完全正常的外观和功能.所有患者对治疗结果表示满意.结论即使是伤后长达3个月的陈旧性锤状指,采用支具固定这种简单、廉价而并发症少的治疗方法,仍然可以取得满意的结果.对于选择恰当的陈旧性锤状指患者,保守治疗仍然是治疗的首选方法.
목적 연구개량지구고정치료상후1개월이상진구건성추상지적림상효과.방법 자2007년11월지2010년1월,대26례진구건성추상지환자채용개량지구고정.종수상도접수고정시간위4～14주,평균7주.아문대전통고정지구진행개량,유근지간관절굴곡、원지간관절과신위고정,개위근지간관절신직、원지간관절경도과신,이증가고정적뢰고성.엄격고정6주후,거제외고정,개시공능연습,병용야간지구계속고정4주.결과 26례중,4례실방,22례획득수방,시간위2～6개월,평균3개월.접수치료적수지균교치료전유명현적개선.원지간관절신직각도치료전평균위-38°(-15°～-70°),치료후위-2°(0°～-10°).안조Patel평정법평정:우19례,량3례.유3례재고정과정중,유우고정점대압박,출현원지간관절일과성동통、종창;조정지구고정점대후,증상완해,능구계속고정.1례거제고정1주후출현15°적굴곡기형,중신고정4주,획득완전정상적외관화공능.소유환자대치료결과표시만의.결론 즉사시상후장체3개월적진구성추상지,채용지구고정저충간단、렴개이병발증소적치료방법,잉연가이취득만의적결과.대우선택흡당적진구성추상지환자,보수치료잉연시치료적수선방법.
Objective To evaluate the clinical results of modified thermoplastic splint for treatment of chronic tendinous mallet finger deformity that were 4 weeks or more old. Methods From November 2007 to January 2010, Twenty-six patients with chronic tendinous mallet deformities were treated with closed extension thermoplastic splint. The duration of the deformity before presentation ranged from 4 to 14 weeks, with an average duration of 7 weeks. We modified the current popular mallet splinting technique that immobilizes the DIP joint in extension and PIP joint in flexion to immobilizing the PIP joint in full extension and DIP joint in slight hyperextension. After 6 weeks continuous splinting, only night splinting was continued for an additional period of 4 weeks. The splint was removed and active mobilization of the finger was encouraged. Results Of the 26 patients, 22 could be reexamined and 4 were not available for follow-up. The average follow-up period was 3 months (range, 2 to 6 months). The average pretreatment extension lag of the DIP joint was - 38°( range, - 15°to -70°), and the average post-treatment extension lag was - 2°( range, 0° to - 10°). Based on Patel's criteria, we had 19 patients with excellent results, and 3 with good results. Three patients developed pain and edema on the dorsum of the DIP joint from a dorsal nylon self-fastening strap. The symptoms were gone after the splints were adjusted. In 1 patient, the deformity recurred in the first week after splinting was discontinued, and he had excellent results after resplinting for an additional period of 4 weeks. Satisfaction was expressed by all patients. Conclusion Splinting is a predictable, safe, and simple method of treatment for chronic mallet fingers that were even 3 months old. This low-morbidity, low-cost treatment should be the method of choice for patients that fulfill the outlined selection criteria.