人工指间关节置换术治疗创伤性指间关节炎

Interphalangeal joint replacement arthroplasty for the treatment of traumatic arthritis

目的探讨人工指间关节置换术治疗手指创伤性关节炎的临床疗效和手术要点。方法2005年3月至2010年12月我科收治的5例陈旧性外伤后指间关节创伤性关节炎患者进行人工指间关节置换手术，并对手术适应证、术中屈伸肌腱病损治疗以及术后功能锻炼进行评估。结果术后5例患者手术切口愈合均为Ⅰ类甲等，术后2周拆线，平均随访1．5年，指间关节伸指0°，屈曲90°，活动时无疼痛，采用拇指的主动对掌功能（TAM）手功能评定：优3例，良2例。结论手部人工关节置换术是治疗手指间关节创伤性关节炎的有效方法，术前明确适应证，术后功能锻炼尤为重要。

Objective To investigate the clinical effects and operation key-points of interphalangeal joint replacement arthroplasty for the treatment of traumatic arthritis. Methods From March 2005 to December 2010, 5 patients with post-traumatic arthritis undergoing interphalangeal joint replacement arthroplasty in our hospital were selected. The operation indications, treatment of intraoperative flexor and extensor tendon lesion and postoperative rehabilitation were evaluated. Results Operative incisions of 5 cases were primary healing in class I grade A. Stitches were taken out 2 weeks after the operation. Patients were followed up for 1.5 years. The range of interphalangeal joint motion was 0 to 90 （extension/flexion） with no pain at end of follow-up. The hand function was excellent in 3 cases and good in 2 cases according to total active motion （TAM） hand function evaluation. Conclusions Interphalangeal joint replacement arthroplasty is an effective treatment for traumatic arthritis. Preoperative indications evaluation and postoperative rehabilitation should be focused on the treatment.