伸直受限型手指掌指关节交锁的诊断与治疗

DIAGNOSIS AND MANAGEMENT OF METACARPOPHALANGEAL JOINT LOCKING WITH EXTENSION LAG

目的探讨伸直受限型手指掌指关节交锁的临床特点、诊断和治疗方法。方法 2009年2月-2014年4月,收治17例(17指)伸直受限型掌指关节交锁患者。男4例,女13例;年龄20~72岁,平均40.7岁。示指12例,中指5例。均为掌指关节于屈曲约30°位时突然发生主、被动伸直受限,不伴屈曲运动障碍。掌指关节活动度(range of motion,ROM)为(41.2±5.1)°,疼痛视觉模拟评分(VAS)为(2.7±0.5)分。X线片及CT检查示,15例原发性交锁者掌骨头桡侧髁明显突出,2例退行性交锁者掌骨头尺侧髁骨赘增生伴关节退变。交锁后1 h^1周就诊,先行手法解锁,手法解锁失败再行手术解锁。结果手法解锁成功5例;除4例手法解锁失败放弃治疗外,手术解锁成功8例。所有成功解锁患者获随访,随访时间6个月~5年2个月,平均2.3年。手法解锁者3例复发,手术解锁者均无复发。末次随访时,掌指关节ROM为(80.4±6.6)°,与解锁前比较差异有统计学意义(t=—19.46,P=0.00)。VAS评分为(0.2±0.4)分,与解锁前比较差异有统计学意义(t=13.44,P=0.00)。结论掌指关节副侧副韧带钩绊于掌骨头桡侧髁突是伸直受限型掌指关节交锁最常见的发生机制。手法解锁有一定成功率,但可能复发;手法解锁失败或再次复发后经手术解锁疗效满意,术后无复发。

Objective To investigate the clinical characteristics, diagnosis, and treatment of metacarpophalangeal （MCP） joint locking with extension lag. Methods Between February 2009 and April 2014, 17 patients （17 fingers） with MCP joint locking with extension lag were treated. The patients included 4 males and 13 females, and the average age was 40.7 years （range, 20-72 years）. The index finger was locked in 12 cases and the middle finger in 5 cases. All patients could not fully extend the MCP joint at about 30° flexion without flexion limitation of the interphalangeal joint. The range of motion （ROM） of the MCP joint was （41.2 ± 5.1）°. The visual analogue scale （VAS） score was 2.7 ± 0.5. X-ray and CT scanning showed that there was a bony prominence on radial condyle of the metacarpal head in 15 primary patients, and a hook like osteophyte on ulnar condyle in 2 degenerative patients. All patients were treated with close reduction first, and open reduction was conducted when the manipulation failed. Results Successful close reduction was achieved in 5 cases, and successful open reduction in 8 cases; 4 cases gave up treatment after failure for close reduction. All patients who achieved successful reduction were followed up 2.3 years on average （range, 6 months to 5 years and 2 months）. The ROM of the MCP joint was increased to （80.4 ± 6.6）° at last follow-up, showing significant difference when compared with ROM before reduction （t= —19.46, P=0.00）. The VAS score decreased to 0.2 ± 0.4 at last follow-up, also showing significant difference when compared with score before reduction （t=13.44, P=0.00）. Conclusion Accessory collateral ligament caught at the bony prominence on the radial condyle of the metacarpal head is the most common cause of the MCP joint locking with extension lag. Close reduction is feasible, but recurrence of locking is possible. Surgical treatment is advised in the event of manipulation failure or recurrent locking.