摘要
目的探讨应用分期手术治疗中、晚期前臂缺血性肌挛缩的疗效。方法对32例中、晚期前臂缺血性肌挛缩的患者,进行分期手术治疗。一期行血管、神经松解,前臂屈肌群起点滑移、肌腱延长或变性肌肉切除术。二期行伸肌腱转位或肌肉移植术(带蒂或游离)。三期行肌腱粘连松解或手内在肌功能重建术。结果32例分期手术患者,术后获得10～24个月的随访。手功能评定:优(S3M4)22例,良 (S3M3)6例,可(S2M2例,差(S1M0)2例,腕背伸>30°,握力达健手70％以上者22例;腕背伸20°,握力达健手55％以上者6例,优良率为87．5％。结论分期手术结合系统康复锻炼,是治疗中、晚期前臂缺血性肌挛缩的有效治疗方法。
Objective To observe the clinical outcome of surgical treatment of Volkmann contraeture with a three-stage operation. Methods 32 cases of late Valkmann contracture of the forearm treated with a three-stage operation from 1992 to 2004 were involved in the study. In the first stage operation, distal sliding of flexor muscles and exploration of the vasculature and nerves were performed, the degenerated and necrosed muscles which lost its elasticity were severed or reseeted to improve the extension of the wrist, the fingers and the thumb. The muscles were preserved or lengthened if their elasticity was good. In the second stage, tendon transfer, free or pedieled muscle transfer was performed. In the third stage, tenolysis and reconstruction of intrinsic muscle function were performed, followed with a 2-3 months rehabilitation regimen, long-term outcomes of hand function was assessed. Results Postoperative followup ranged from 10 to 24 months. 22 eases were graded as excellent （S3M4）, 6 as good（S3M3）, 2 as fair （S2M2）, and 2 as poor （S1M0）. 22 eases achieved wrist extension of more than 30 degrees and grip strength of more than 70% of that of the eontralateral side. 6 eases had wrist extension of more than 20 degrees and grip strength of more than 55 % of that of the eontralateral side. The overall satisfactory rate was 87.5 %. Conclusion A staged operation combined with supervised rehabilitation was an effective approach for improving functional recovery of late Volkmann eontraeture.
出处
《中华手外科杂志》
CSCD
北大核心
2006年第3期170-171,共2页
Chinese Journal of Hand Surgery
