手指之近位指間關節旋轉性半脫位：一病例報告

手指之近位指間關節旋轉性半脫位是較為罕見的手部外傷，它是一種近位指間關節往掌側半脫位的外傷，其發生之原因，大多是因為手指之扭轉傷害而引起。正確診斷一定要有手指之側面X光照相才可顯現近位指間關節往掌側半脫位，它與一般常見的此關節之背面或側面脫位之治療有所不同。此種旋轉性半脫位常不容易閉鎖復位，大部份均須開刀復位，這是因為中位指骨之尺側踝部或是橈側踝部從伸指肌腱之外側帶及中心帶之間的破洞突出，如同扭扣被扭扣口夾住般。我們報告一例此種罕見之病例，此病人經過多次閉鎖復位失敗後，於一星期後轉本院開刀復位成功，截至目前此關節無發生疼痛現象，但關節運動彎曲喪失10度，伸直喪失7度，此可能因多次閉鎖復位失敗，及延誤開刀復位時間所導致的。故早期正確診斷，然後嘗試閉鎖復位一或二次，如失敗則需開刀復位才可得到滿意之結果。

關鍵字

旋轉性半脫位；近位指間關節；復位不易

並列摘要

A patient with rotatory subluxation of the proximal interphalangeal joint of the right index is described. Repeated close reductions failed. Open reduction was then done through a curved dorsal incision. There was a longitudinal tear between the central slip and the ulnar lateral band, which was shifted downward. There was also a total rupture of the ulnar collateral ligament. The ulnar condyle of the middle phalangeal bone was trapped between the tendinous noose. Reduction was done by flexing the proximal interphalangeal joint and then retracting the lateral band and lifting it from its volar displaced position around to the side of the condyle. The ulnar collateral ligament and the rent in the extersor mechanism were repaired. The finger was immobilized for 2 weeks before exercises were initiated. Six months after the operation, there was a 7-degrees loss of extension and a 10-degrees loss of flexion of the proximal interphalangeal joint with no pain. Palmar subluxations of the proximal interphalangeal joints are unusual injuries that sometimes cannot be reduced by close reduction, unlike the more common dorsal and lateral dislocations of the proximal interphalangeal joints. The cause of irreducibility was the interposition of one lateral band about the ulnar or radial condyle of the middle phalangeal bone.

並列關鍵字

rotatory subluxation ； proximal interphalangeal joint ； irreducibility

國際替代計量

手指之近位指間關節旋轉性半脫位：一病例報告

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