摘要
目的:探讨前臂缺血性肌挛缩症的临床分期及其治疗方法。方法:将前臂缺血性肌挛缩症划分为急性缺血期(24h以内)、挛缩期(24h^6个月)和畸形固定期(6个月以上),挛缩期又分为挛缩进行期(24h^1个月)和挛缩恢复期(1~6个月)。急性缺血期5例均采用筋膜切开减压术治疗;挛缩期采用神经血管松解术16例,坏死肌肉和神经切除神经移植、肌腱移位术1例;畸形固定期19例均采用屈肌起点下移术治疗,其中5例曾于挛缩期做过神经、血管松解术,1例在畸形期做过肌腱延长术。结果:经2个月~20a随访,急性缺血期5例疗效均优;挛缩进行期7例中,优3例、良2例、可1例、差1例;挛缩恢复期10例中,优3例、良3例、可3例、差1例;畸形固定期19例中,优9例、良5例、可4例、差1例。结论:急性缺血期筋膜切开减压术、挛缩期积极的神经松解术及畸形固定期前臂屈肌起点滑移术是前臂缺血性肌挛缩症不同临床分期的最有效治疗方法。
Objective：To discuss the clinical stage and treatment of ischemic muscle contracture in forearm. Methods：The development of ischemic muscle contracture in forearm was divided into 3 stages： acute ischemic stage（ less than 24 hours）, contracture stage （24 hours- 6 months） and deformity stage （more than 6 months）. The radical- compartmental excision was applied in acute ischemic stage in 5 cases,the decompression of nerve and vessel was performed in the contracture stage in 16 cases and the excision of necrosis muscle, nerve and nerve - replantation, tendon - shift was performed in 1 case. Sliding operation of flexor muscles was performed in the deformity stage in 19 cases including 5 cases performed decompression of nerve and vessel and tendon lengthening procedure in the deformity stage in 1 case. Results：All the patients were followed up for 2 months- 20 years.The resuits were excellent in all the 5 cases at the acute ischemic stage. 6 of the 7 cases at the contracture developing stage（ less than 1 month） received decompression of nerve and vessel. The results were excellent in 3 cases, good in 2 cases and fair in 1 case. The result was bad for the other case who received excision of necrosis muscle, nerve and nerve - transplantation and tendon shift. For the patients at the contracture recovering stage （ 1 - 6 months） receiving depression of nerve, The results were excellent in 3 cases, good in 3 cases, fair in 3 cases and bad in 1 case. For the patients at the deformity stage undergoing sliding operation of flexor muscles, the results were excellent in 9 case,good in 5 cases,fair in 4 cases and bad in 1 case. Conclusion： Radical - compartmental excision should be applied to patients with ischemic muscle contracture in forerm at the acute iscbemic stage, nerve-decompression for patients at the contracture stage and sliding operation of flexor muscles for patients at the deformity stage so as to achieve the best outcome.
出处
《解剖与临床》
2005年第3期173-174,180,共3页
Anatomy and Clinics
关键词
前臂
缺血
肌挛缩
临床分期
Forearm
Ischemia
Muscle contracture
Clinical stage
