三例先天性前臂尺侧指深屈肌挛缩临床特点及治疗分析

Clinical characteristics and treatment analysis of three cases of congenital ulnar collateral flexor contracture of the forearm

目的总结3例先天性前臂尺侧指深屈肌挛缩患者临床特点及诊治经验,为临床提供参考。方法2019年2月—2021年8月,收治3例先天性前臂尺侧指深屈肌挛缩患者。男2例,女1例;年龄分别为16、20、16岁。病程8、20、15年,均表现为腕关节中立位或腕伸位时,中、环、小指近侧指间关节和远侧指间关节屈曲畸形,且腕伸位时畸形加重;手总主动活动度(total action motion,TAM)评分均为1分、分级为差,Carroll手功能评定法评分为48、55、57分,握力指数为72.8、78.4、30.5。术前例2 CT检查示指深屈肌腱在尺骨近端止点处有骨性突起;例3前臂MRI检查示尺侧指深屈肌呈均一条索带状结构。确诊后均择期行手术松解变性肌腱治疗,术后早期开始功能锻炼。结果术后切口均Ⅰ期愈合。3例患者均获随访,例1~3随访时间分别为12、35、12个月。患者手部整体功能以及患指关节活动明显提高,但握力无明显提升。末次随访时,TAM评分分别为3、4、4分,其中优2例、良1例;Carroll手功能评定法评分为95、90、94分,握力指数分别为73.5、81.3、34.2。结论先天性指深屈肌挛缩是临床罕见疾病,应与缺血性肌挛缩相鉴别,明确挛缩部位并选择合适手术时机进行手术松解,术后积极康复功能锻炼,可获得良好手功能。

Objective To report the clinical characteristics and treatment analysis of 3 cases of congenital ulnar collateral flexor contracture of the forearm and take a reference for clinic.Methods A total of 3 patients with congenital ulnar collateral flexor contracture of the forearm were admitted between February 2019 and August 2021.Two patients were male and 1 was female,and their ages were 16,20,and 16 years,respectively.The disease durations were 8,20,and 15 years,respectively.They all presented with flexion deformity of the proximal and distal interphalangeal joints of the middle,ring,and little fingers in the neutral or extended wrist position,and the deformity worsened in the extended wrist position.The total action motion(TAM)scores of 3 patients were 1 and the gradings were poor.The Carroll’s hand function evaluation scores were 48,55,and 57,and the grip strength indexes were 72.8,78.4,and 30.5.Preoperative CT of case 2 showed a bony protrusion of the flexor digitorum profundus tendon at the proximal end of the ulna;and MRI of case 3 showed that the ulnar flexor digitorum profundus presented as a uniform cord.After diagnosis,all patients were treated with operation to release the denatured tendon,and functional exercise was started early after operation.Results The incisions of 3 patients healed by first intention.Three patients were followed up for 12,35,and 12 months,respectively.The hand function and the movement range of the joints significantly improved,but the grip strength did not significantly improve.At last follow-up,TAM scores were 3,4,and 4,respectively,among which 2 cases were excellent and 1 case was good.Carroll’s hand function evaluation scores were 95,90,and 94,and the grip strength indexes were 73.5,81.3,and 34.2,respectively.Conclusion Congenital ulnar collateral flexor contracture is a rare clinical disease that should be distinguished from ischemic muscle contracture.The location of the contracture should be identified and appropriate surgical timing should be selected for surgical release.Active postoperative rehabilitation and functional exercise can achieve good hand function.