摘要
目的 探讨断掌、腕再植术后手内在肌挛缩的原因,结合临床经验提出治疗方法和预防措施。方法 1985 年1997 年进行断掌、腕再植48 例49 只手,发生程度不等的拇收肌挛缩9 例和手内在肌挛缩6 例,其中2 例拇内收肌轻度挛缩采用保守治疗,7 例拇内收肌中度以上挛缩和6 例手内在肌挛缩均采用手术治疗。对15 例肌挛缩的发生机制、治疗结果、预防措施进行讨论。结果 拇内收肌挛缩术后功能恢复良4 例,中5 例;手内在肌阳性挛缩术后功能恢复良3 例,中1 例;手内在肌条束状硬结挛缩术后功能恢复中1 例,差1 例。随访110 年,无1例复发。断掌、腕再植手术后,拇收肌和手内在肌挛缩的发生及其程度与再植体缺血时间的长短密切相关,再植术后拇收肌挛缩和手内在肌挛缩诊断一旦成立,其保守治疗和手术治疗效果均不理想。结论 断掌、腕再植术后拇收肌挛缩和手内在肌挛缩重在预防。对再植体缺血时间已达12 小时以上的断掌、腕再植,应及时行手内在肌筋膜间区减压。
Objective To explore the pathogenic mechanism of intrinsic muscle contracture after replantation of severed palm or wrist, and put forward the prevention and treatment methods. Methods\ From 1985 to 1997, 48 cases were received replantation of severed palm or wrist, among them, 9 cases with thumb adductor contracture and 6 cases with intrinsic muscle contracture were occurred in different degree. Two cases with mild thumb adductor contracture were received conservative treatment, and 7 cases with moderate thumb adductor contracture and 6 cases with intrinsic muscle contracture were received operative treatment. The pathogenic mechanism, clinical results, and prevention methods were studied in those 15 cases. Results\ The postoperative function recovery was better in 4 cases, moderate in 5 cases with thumb adductor contracture, and better in 3 cases, moderate in 1 case with intrinsic muscle contracture, and moderate in 1 case, poor in 1 case with intrinsic muscle contracture of cord like induration. Followed up 1 to 10 years, no recurrence was observed in all of 15 cases. The incidence and degree of thumb adductor contracture and intrinsic muscle contracture were closely related to the ischemia time of replanting graft. Conclusion\ Prevention of thumb adductor contracture and intrinsic muscle contracture is most important in severed palm or wrist replantation. When the ischemia time of replanting graft is longer than 12 hours, the effective decompression in myofascial compartment is performed in time to reach satisfactory result.
出处
《中国修复重建外科杂志》
CAS
CSCD
2000年第1期27-28,共2页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
肌挛缩
断掌腕再植术
手内在肌
防治
Severed palm or wrist replantation Intrinsic muscle of hand Contracture Microsurgery
