先天性指深屈肌起点异常致中环小指渐进性屈指畸形的诊治

The diagnosis and treatment of progressive flexion deformity of the long, ring and little fingers with an aberrant origin of flexor digitorum profundus

目的 探讨因先天性指深屈肌起点异常造成的中环小指渐进性屈指畸形的诊断、鉴别诊断及手术治疗.方法 对2例因先天性指深屈肌起点异常造成的中环小指渐进性屈指畸形患者行手术治疗,采用异常屈肌起点的切断和部分指屈肌起点滑移的方法,术后第2天即开始主动屈、伸指功能锻炼结合背伸牵引支具预防再挛缩,术后疗效评估包括主动关节活动范围、握力和患者主观满意度.结果 2例患者术后伤口均Ⅰ期愈合,至最后随访日均能在腕关节背伸20°位,中环小指主动充分伸直,患手握力达到对侧的80％～90％,2例患者对手术疗效均表示非常满意,未见屈指畸形的复发.结论 对于无明显外伤所致的中环小指渐进性屈指畸形,如果在影像学检查中明确有尺骨近端的朝向远端的骨赘形成,则要高度考虑先天性指深屈肌起点异常的可能性,可采用切断异常束带＋指屈肌起点松解滑移的手术方式,结合术后早期功能锻炼,均可取得满意的功能恢复.

Objective To explore the diagnosis,differential diagnosis and surgical strategies of progressive flexion deformity of the long,ring and little fingers caused by an aberrant origin of the flexor digitornm profundus.Methods Two patients with progressive flexion deformity of the long,ring and little fingers with congenital aberrant origin of the flexor digitorum profundus were surgically treated.In both cases,the aberrant tendinous band was excised from the origin,and further muscle-sliding procedure was performed until all the fingers could be fully extended passively even with the wrist extended to 30°.Active flexion extension exercises of the involved fingers began from the 2nd day postoperatively with an extension traction splint to prevent recurrence of the contraction.The results were evaluated in respect of active range of motion,grip strength and subjective satisfaction.Results After the surgery,the wounds healed primarily.All the fingers could extend fully actively when the wrist extended to 20°.The grip strength of the involved hand was 80％ to 90％ to that of the contralateral hand.Both patients were very satisfied with the surgical results.There was no recurrence of flexion contraction deformity.Conclusion Existence of congenital aberrant origin of the flexor digitorum profundus should be considered in patients with progressive flexion deformity of the long,ring and little fingers without previous trauma history and with a bony prominence at the proximal end of the ulna on radiographs.The operation includes excision of the aberrant tendinous band and distal muscle-sliding.Combined with early postoperative active exercises,the patients can get satisfactory results.