分段式海豚腱切开术治疗布顿畸形：尸体研究

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2024-11-01 DOI:10.1016/j.jhsg.2024.08.006

Karly Lorbeer MD , Andrew D. Allen MD , Alexander D. Jeffs MD , Emily Jewell MD , Nathaniel C. Adams BA , Eric Van Buren PhD , Feng-Chang Lin PhD , Reid W. Draeger MD

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引用次数: 0

摘要

目的末端伸肌腱膜切开术或Dolphin腱膜切开术是一种用于治疗慢性拇指畸形中远端指间关节（DIP）过度伸展的治疗方法。本研究的目的是研究渐进式部分 Dolphin 腱切开术在矫正拇指畸形中的效果，重点是评估 DIP 关节过度伸展畸形的改善情况，并记录先天性槌状指的发生情况。我们通过横断中央滑脱并用 3 毫米的间隙进行修复，在每个指头上创建了拇指畸形。我们通过分离三分之一、二分之一、三分之二和完全横断的方式，对末端伸肌腱鞘进行了递增式分段切除。结果该模型产生的平均DIP关节过伸畸形为-15 ± 1°。在进行三分之一（-11 ± 1°）、二分之一（-9 ± 1°）和三分之二（-5 ± 1°）韧带切除术后，DIP关节位置依次得到改善。完全腱膜切除术导致平均 25° 的外展滞后。任何程度的点阵式腱膜切开术对 PIP 关节屈曲畸形均无明显改善（P> 0.05），完全腱膜切开术后仅有轻微改善（从 48 ± 2° 到 41 ± 2°，P< 0.05）。临床意义对于PIP关节畸形轻微、DIP关节过度伸展为主要功能障碍的慢性拇指畸形患者，临床应用点状末端伸肌腱膜切开术可能是一种有效的治疗选择。分段式腱膜切除术可让外科医生根据术前存在的畸形情况来调整矫正程度。

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Fractional Dolphin Tenotomy for Boutonniere Deformity: A Cadaveric Study

Purpose

Terminal extensor tenotomy or Dolphin tenotomy, is a described treatment for the management of distal interphalangeal (DIP) joint hyperextension in chronic boutonniere deformity. The purpose of this study was to investigate the effects of incremental partial Dolphin tenotomy in correcting boutonniere deformity, with a focus on evaluating the improvement in DIP joint hyperextension deformity and documenting the development of iatrogenic mallet finger.

Methods

Thirty-eight fingers from 10 cadaveric hands were used. We created a boutonniere deformity in each digit by transecting the central slip and repairing it with a 3-mm gap. We performed incremental fractional terminal extensor tenotomy by detaching one-third, one-half, two-thirds, and complete transection. The positions of the proximal interphalangeal (PIP) and DIP joints were measured in the extended position following each subsequent tenotomy.

Results

The model produced an average DIP joint hyperextension deformity of −15 ± 1°. The DIP joint position sequentially improved with one-third (−11 ± 1°), one-half (−9 ± 1°), and two-thirds (−5 ± 1°) tenotomy. Complete tenotomy resulted in an average 25° extensor lag. There was no significant improvement in PIP joint flexion deformity with any degree of fractional tenotomy (P > 0.05), and only mild improvement after complete tenotomy (48 ± 2° to 41 ± 2°, P < 0.05).

Conclusions

Fractional terminal extensor tenotomy demonstrated incremental improvement in DIP joint hyperextension deformity with increasing degree of tenotomy performed. There were no cases of iatrogenic mallet finger with fractional tenotomy involving up to two-thirds of the tendon.

Clinical relevance

Clinical application of fractional terminal extensor tenotomy may be an effective treatment option for patients with chronic boutonniere deformity in whom PIP joint deformity is mild and DIP joint hyperextension accounts for the primary functional deficit. Fractional tenotomy may allow the surgeon to tailor the degree of correction to the existing preoperative deformity.

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