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- 주제어 : Boutonniere Deformity (검색결과 4 건)
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Jun-Ku Lee,Soonchul Lee,Minwook Kim,Seongmin Jo,Jin-Woo Cho,Soo-Hong Han 대한정형외과학회 2021 Clinics in Orthopedic Surgery Vol.13 No.2
Background: The rupture of the central slip of an extensor tendon of a finger causes a boutonniere (or buttonhole) deformity, characterized by pathologic flexion at the proximal interphalangeal (PIP) joint and hyperextension at the distal interphalangeal (DIP) joint. Currently, there are no standard treatment guidelines for this deformity. This study aimed to report clinical results of surgery to correct chronic boutonniere deformity. Methods: This retrospective case series was conducted between January 2010 and December 2018 and only 13 patients with trauma-induced chronic deformity were included. After excision of elongated scar tissue, a direct anatomic end-to-end repair using a loop suture technique with supplemental suture anchor augmentation was conducted. Total active motion was assessed before and after surgery and self-satisfaction scores were collected from phone surveys. Results: All patients presented with Burton stage I deformities defined as supple and passively correctable joints. The initial mean extension lag of the PIP joint (43.5°) was improved by an average of 21.9° at the final follow-up (p < 0.001). The mean hyperextension of the DIP joint averaged 19.2° and improved by 0.8° flexion contracture (p < 0.001). The average total active motion was 220.4° (range, 160°–260°). Based on the Souter’s criteria, 69.2% (9/13) of the patients had good results. Only 1 patient reported fair outcome and 23.1% (3/13) reported poor outcome. The average Strickland formula score was 70 (range, 28.6–97.1). In total, 10 patients (77%) had excellent or good results. Of 10 patients contacted by phone, self-reported satisfaction score was very satisfied in 2, satisfied in 3, average in 3, poor in 1, and very poor in 1. Three patients reported a relapse of the deformity during range of motion exercises, 1 of whom underwent revision surgery. One patient complained of PIP joint flexion limitation, and 2 complained of DIP joint flexion limitation at final follow-up. Conclusions: In chronic boutonniere deformity, central slip reconstruction with anchor suture augmentation can be an easily applicable surgical option, which offers fair to excellent outcome in 77% of the cases. The risk of residual extension lag and recurrence of deformity should be discussed prior to surgery.
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단추구멍 변형: 치료 전 고려사항과 현재의 치료 대안들에 대한 종설
이준구,김충기,한수홍 대한수부외과학회 2020 대한수부외과학회지 Vol.25 No.4
중앙 건(central slip) 손상은 수부 외상에서 흔하게 발생한다. 중앙 건의 닿는 부분인 중위지골 배측 기저 부분이 약화 혹은 손상되면, 근위 지관절(proximal interphalangeal joint)은 신전 지연(extension lag) 혹은 제한이 되고 원위 지관절(distal interphalangeal joint)은 과신전을 보이는 ‘단추구멍 수지 변형(boutonniere or buttonhole deformity)’이 발생할 수 있다. 이에 대해서는 수부외과의가 경험할 수 있는 증례가 적고 현재까지도 명확한 치료지침이 없어, 담당 의사의 지식과 경험에 의존해 치료가 결정되는 경향이 있다. 따라서 단추구멍 변형의 치료 결정시 고려해야 할 요소들을 논의하고, 비수술적 혹은 수술적 치료에 대해 고찰하고자 한다. 단추구멍 변형에서 근위 지관절의 치료는 어려운 과제이다. 변형의 원인, 변형까지의 경과 시점 및 단계, 인접 관절의 생체역학적 변화와의 관련성, 환자의 기능적 제한점 및 관절 상태에 대한 이해는 치료의 결정과 이로 인한 결과를 향상시킬 것이다. 이런 고려 사항을 바탕으로 비수술적 혹은 수술적 치료 중 적절한 술기를 선택해야 한다. 변형에 대한 충분한 이해와 치료 과정, 결과, 재활에 관해 환자와 충분한 상의와 협조가 필요하다. Central slip injury is a common occurrence in hand trauma. When the base of the middle phalanx, which is the contact part of the central tendon, is weakened or damaged, extension lag or restriction would be found in the proximal interphalangeal (PIP) joint and the distal interphalangeal joint becomes hyperextended, presenting buttonhole or boutonniere deformation. Buttonhole deformation has limited cases that a hand surgeon can experience, and there is still no clear guideline for treatment, so treatment tends to depend on the knowledge and experience of the treating doctor. In this review, the factors to be considered in determining the treatment of boutonniere deformity are discussed, and nonsurgical or surgical treatment is considered. Treatment of the PIP joint in boutonniere deformity is a difficult task. Understanding the cause of the deformity, the time point and the stage of deformity, the relationship to the biomechanical changes in adjacent joints, the patient’s functional limitations, and the condition of the joint will improve treatment decisions and outcomes. Based on these considerations, an appropriate treatment should be chosen among nonsurgical or surgical treatments. Various surgical options were introduced but none of method guarantee the optimal outcome. Sufficient understanding of deformity and sufficient consultation and cooperation with the patient regarding the treatment process, outcome, and rehabilitation are necessary.
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