PIP関節屈曲拘縮を有する屈筋腱腱鞘炎の治療

抄録

Objective: A pulley release usually results in an excellent surgical outcome in trigger finger treatment. However, unsatisfactory results are found in some patients due to persistent flexion deformity of the proximal interphalangeal (PIP) joint. We performed an ulnar slip superficialis tendon resection (USSR) in such patients, and relatively good results were obtained.

Methods: Fourteen digits including two index fingers and 12 long fingers in eight female and six male patients, who had undergone USSR, were retrospectively evaluated. The average patient age was 71.5 years old. With respect to the affected digit, the coronal diameter ratio of the flexor tendons to proximal phalanx at the proximal one third level of the aforementioned bone (tendon/bone ratio), was calculated. As a control, the same ratio was also calculated in the ring finger of the ipsilateral hand. The affected digit’s preoperative and postoperative Disabilities of the Arm, Shoulder and Hand (DASH) scores and active extension angles of the PIP joints were evaluated. The postoperative evaluation was performed at the patients’ final visit, and the average follow-up time was eleven months (6 to 19 months).

Results: The average tendon/bone ratio was 87.4% (78.0 to 98.9%) in the affected digit and 67.5% (53.1 to 75.5%) in the control. The preoperative active extension angle of the PIP joint of affected digits was −26.2 degrees on average preoperatively (range: −15 to −45), and −9.1 degrees (range: 0 to −20) after the procedure. The preoperative average DASH functional score was 38.5 points (range: 23.2 to 69.6) and 8.9 points (range: 0.86 to 24.1) postoperatively. The active extension angle improved by 17.1 degrees on average, and the DASH functional score decreased by 29.6 points on average. These differences were significant (P<0.05).

Conclusion: USSR can be a meaningful procedure in trigger finger patients with flexion deformity of the PIP joint.