Một biến dạng boutonniere hoặc cổ thiên nga trong XẢY RA Khoảng một nửa số bệnh nhân viêm khớp dạng thấp. Các nguyên nhân gây ra biến dạng mãn tính boutonniere IS interphalangeal viêm màng hoạt dịch của khớp gần. | Operative Correction of Swan-Neck and Boutonniere Deformities in the Rheumatoid Hand Martin I. Boyer MD MSc FRCSC and Richard H. Gelberman MD Abstract A swan-neck or boutonniere deformity occurs in approximately half of patients with rheumatoid arthritis. The cause of boutonniere deformity is chronic synovitis of the proximal interphalangeal joint. Swan-neck deformity may be caused by synovitis of the metacarpophalangeal proximal interphalangeal or distal interphalangeal joints. Numerous procedures are available for the operative correction of these finger deformities. The choice of surgical procedure is dependent on accurate staging of the deformity which is based on the flexibility of the proximal interphalangeal joint and the state of the articular cartilage. The patientÕs overall medical status and corticosteroid use the condition of the cervical spine the need for operative treatment of large joints and the presence of deformities of the wrist and metacarpophalangeal joints must also be considered when planning treatment. In the later stages of both deformities soft-tissue procedures alone may not result in lasting operative correction. J Am Acad Orthop Surg 1999 7 92-100 Finger deformities are common in persons with rheumatoid arthritis which affects of Americans between the ages of 18 and 79 The incidence of uncor-rectable swan-neck and boutonniere deformities is estimated to be between 8 and 16 during the first 2 years after the onset of systemic disease and the prevalence of finger deformities in patients with established rheumatoid arthritis is approximately 14 for swan-neck deformities and 36 for boutonniere Often the most visible manifestations of rheumatoid arthritis such deformities can be painful and can impair finger and hand function significantly. Principles guiding the operative correction of deformities in the hands of patients with rheumatoid arthritis focus on relief of pain improvement of function and elimi nation of
