閉合性鎚狀指損傷保守療法－以林口長庚醫院整形外科經驗為例

Closed Mallet Finger Injury Conservative Treatment - The Experience in Plastic and Reconstructive Surgery Department of Chang Gung Memorial Hospital at Linkou

連淑惠(Shwu-Huei Lien) ； 林有德(Yu-Te Lin)

《台灣復健醫學雜誌》 48卷1期 (2020/06) Pp. 43-51

https://doi.org/10.6315/TJPMR.202006_48(1).0005

摘要

目的：鎚狀指是手部治療常見的問題，使用矯具療法（orthotic treatment）處理單純伸肌肌腱損傷鎚狀指的保守療法，為目前世界的潮流，不同型式的矯具（orthosis）具備其特有的優缺點，林口長庚整形外科藉由臨床治療的個案系列報告，探討治療鎚狀指（mallet finger）的臨床結果，並分析病人特性、受傷手指、臨床問題與世界其他研究之異同。方法：以病歷回溯研究方式，收集2010年1月至2018年5月期間，在林口長庚整形外科診斷為Doyle第一型閉合性鎚狀指損傷的成年患者，所有患者均單純以客製化矯具（custom-made orthosis）治療，接受治療超過八週且患者表示已經滿意手功能狀態為完成療程的標準，使用克勞福德分類量表（Crawford classification）對患者進行臨床和滿意度等級評估，分析患者性別、年齡層、受傷手與手指的分布。結果：48位成年患者符合收案標準，本研究的年齡、性別比例與患者開始接受治療的時間與其他國家研究相近，但雙手發生機率相近，較常受傷手指為小指及無名指，則有不同。使用克勞福德分類量表分析25位治療超過八週，滿意遠端指間關節活動角度，完成療程的患者，鎚狀指恢復情形的結果：優等佔40％，良好佔28％，尚可佔32％，23位患者只接受一次或二次的治療，即未再回診追蹤，未完成療程患者的受傷側以左手比例較高（60.9%），與完成療程的患者具有統計學上的差異。結論：Doyle第一型閉合性鎚狀指損傷單純以矯具處理，如果配合完整的治療及追蹤，都可以改善鎚狀指問題，得到令患者滿意的療效。

關鍵字

鎚狀指（mallet finger） ； 矯具療法（orthotic treatment）

並列摘要

Objective: Mallet finger injury is a common injury in hand therapy. Orthoses are used as the standard method to conservatively treat simple tendon mallet finger injuries worldwide. Different types of orthoses have advantages and disadvantages. We explored the clinical outcomes of treating mallet fingers by using a series of case reports from the plastic department of Linkou Chang Gung Memorial Hospital, and we analyzed how these outcomes differed across patient characteristics, injured fingers, and clinical problems. We also compared our findings with findings from previous research. Methods: Medical records were reviewed to collect the treatment results of adult patients who were diagnosed with Doyle Type I mallet finger injury in our department from January 2010 to May 2018. All patients were treated with custom-made orthosis. Completion of the treatment was defined as patients treated over 8 weeks and getting subjectively satisfactory hand function. Crawford classification was applied to evaluate the clinical outcome. Patients' gender, age, and distribution of injured hands and finger were analyzed, and the results were compared to other studies. Result: Forty-eight adult patients met the inclusion criteria, and 25 patients completed the treatment program. The age and sex ratio and the time to start treatment in this study were similar to studies in other countries. However, we found that the incidence of mallet finger injury was similar across both hands and that the little finger and ring finger were the most commonly injured fingers. These two findings are in contrast to findings from other studies, which found that mallet finger was more commonly observed on the dominant hand and on the middle finger. The outcomes of the successfully followed up group were excellent in 40% of patients, good in 28%, and fair in 32% based on the Crawford classification. Nearly half of the patients did not return to the clinic after receiving hand therapy one or two times. The left hand was affected in 60.9% of group who was lost to follow-up. The injured side was significantly different between the successfully followed up group and the group lost to follow-up. Conclusion: Orthotic treatment combined with the integration of exercise programs and follow-up assessments can achieve satisfactory functional outcomes for patients with Doyle's type I mallet finger injury.

並列關鍵字

mallet finger ； orthotic treatment

參考文獻

1. Clayton RA, Court-Brown CM. The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury 2008;39(12):1338‐44.

2. Kreuder A, Pennig D, Boese CK, et al. Mallet finger: a simulation and analysis of hyperflexion versus hyperextension injuries. Surg Radiol Anat 2016;38(4):403‐7.

4. Katzman BM, Klein DM, Mesa J, et al. Immobilization of the mallet finger. Effects on the extensor tendon. J Hand Surg Br 1999;24(1):80‐4.

5. Handoll HH, Vaghela MV. Interventions for treating mallet finger injuries. Cochrane Database Syst Rev 2004;(3).

6. Lamaris GA, Matthew MK. The Diagnosis and Management of Mallet Finger Injuries. Hand (N Y) 2017;12(3):223‐8.