Burkhalterらの術式により鉤爪手を矯正した1例

Burkhalter and Strait Procedure for Claw Hand Deformity. Case Report

　症例は21歳，男性．ガラスで右前腕中央屈側を切り受傷し，屈筋腱と正中・尺骨神経の縫合術を施行された．7カ月後，残存した鉤爪手変形に対し，Burkhalterらの術式に準じ，変形矯正手術を行った．移植腱末端を基節骨の中央へ引き抜き固定，中枢を長橈側手根伸筋に縫着した．術後1年半で矯正位は維持されていた．移植腱末端を側索に縫着する方法は，緊張が強いとPIP関節の屈曲障害や指のswan-neck変形が発生しやすい．一方，基節骨に固定する本法は移植腱の緊張を決定しやすく，術後も矯正位がほぼ変わらず維持できるため，鉤爪手矯正法として安全度の高い手術といえる．また，本手術は手内在筋の筋力の自然回復を妨げるものではなく，患者の満足度も高かった．

　The patient was a 21-year-old man with a laceration in the center of the flexor aspect of the right forearm produced by glass. The flexor tendon and the median and ulnar nerve were sutured. Seven months later, a reconstruction operation by the Burkhalter procedure was performed on the remaining claw-hand deformity. The distal end of the grafted tendon was attached to the middle of the proximal phalanx by the pullout wire technique, and the proximal end was sutured to the extensor carpi radialis longus. One year after the operation, the corrected position had been maintained. Attachment of the graft to the proximal phalanx in the present procedure, made it possible to establish the correction range easily and broadly, and the corrected position can be maintained almost unchanged after the operation. Therefore, this can be said to be a safe surgical procedure. Since the intrinsic reconstruction is not a disadvantage in terms of the natural recovery of intrinsic muscle, we should choose this operation without waiting. The patient was satisfied with the excellent function of the hand.