小指近侧指间关节掌腱膜挛缩症的治疗

目的探讨小指近侧指间关节掌腱膜挛缩症的治疗方法。方法2000年以来，我院共治疗9例（15侧）小指近侧指间关节掌腱膜挛缩症的患者，采用指掌侧挛缩皮肤“Z”字成形，并在扩大切除掌腱膜的同时，切除受累小指的中央索、螺旋索、侧方指膜、小鱼际肌向小指近侧指间关节移行的尺侧腱膜及小指近侧指间关节处骨化的腱膜。结果术后14侧切口Ⅰ期愈合；1侧皮肤部分坏死，换药后愈合。术后随访时间8个月～2年，平均1．6年，小指能完全伸直，皮肤无挛缩，手指屈伸活动基本正常，术后无其他并发症，无1例复发。结论小指掌腱膜切除的同时，应将受累指的中央索、螺旋索、侧方指膜、小鱼际肌向小指近侧指间关节移行的尺侧腱膜及小指近侧指间关节处骨化的腱膜一并切除。     

掌腱膜挛缩症的治疗

我科自 1980～ 1998年共收治掌腱膜挛缩症 2 1例 ,均采用手术治疗 ,疗效满意 ,报道如下。1　临床资料本组 2 1例 ,2 5只手 ,男 19例 ,女 2例 ;年龄 35～ 70岁 ,平均 5 2 5岁 ,其中 5 0岁以上占 85 7% ;手外伤史 5例 ,家族史8例 ;双侧发病 4例 ,单侧发病中左侧 8例 ,右侧 9例。2　治疗方法在臂丛麻醉、止血带操纵下手术 ,根据病变程度均采取两种不同术式。掌腱膜大部切除术 16例 :以环小指明显功能受限为主者 ,行尺侧掌腱膜大部切除术 ,切口采用多“Ｚ”字、Ｖ Ｙ和多Ｓ型。术中切除尺侧掌腱膜、小鱼际肌及蚓状肌表面肥厚的筋膜 ,还要切除…     

掌腱膜挛缩症50例报告

目的讨论掌腱膜挛缩症的病因，病变特点及治疗方法。方法总结和分析经手术治疗的掌腱膜挛缩症５０例７８只手。其中包括取掌腱膜作病理检查的１１例。行掌腱膜大部切除、手掌及手指挛缩皮肤“Ｚ”成形术６３只手，掌腱膜及受累皮肤一并切除后行游离植皮术１５只手。结果术后平均随访６．４年，见挛缩解除，疗效肯定，无１例复发。１４只手产生并发症如神经损伤、皮下血肿、皮片成活不良及伤口Ⅱ期愈合等占１７．８％。组织学检查结果：均为致密结缔组织增生。结论掌腱膜挛缩症国人报道较少，常发生于中、老年，男性居多，手术治疗效果肯定。为减少并发症的发生，建议在屈曲挛缩已形成功能障碍时即应手术治疗     

掌腱膜挛缩症的临床及病理基础

目的 :探讨掌腱膜挛缩症的病理改变与疗效之间的关系 ,为合理选择手术方式提供依据。方法 :对 2 6例掌腱膜挛缩症患者共 2 9只手进行手术治疗 ,其中 12只手单纯作掌腱膜切除术 ,17只手行掌腱膜切除 受累皮肤切除术 ,对其疗效进行平均 4.6年的随访 ;并对 2 4例掌腱膜标本作病理学及免疫组化检测。结果 :所有行免疫组化检测的病变掌腱膜标本中均有α -平滑肌肌动蛋白的表达 ;单纯掌腱膜切除组的术后复发率为 5 8.33 % ,掌腱膜切除 受累皮肤切除组术后复发率 11.76 %。结论 :掌腱膜挛缩症的病理改变不仅仅局限在掌腱膜 ,也可累及皮下组织和皮肤。因此 ,对病变已侵及皮肤的病例应作掌腱膜切除 受累皮肤切除术。     

掌腱膜挛缩症中手指屈曲畸形治疗的临床研究

目的 研究掌腱膜挛缩症中手指屈曲畸形矫治方法 及其疗效.方法 本组患者17例,其中男性15例,女性2例;平均年龄58岁.均有掌腱膜挛缩症,伴小指屈曲挛缩8侧,伴环小指屈曲挛缩8侧,伴中环指屈曲挛缩1侧,伴环指屈曲挛缩2侧,共19侧.沿掌腱膜挛缩索带纵轴设计锯齿状切口,彻底切除病变的挛缩腱膜组织及其附近5 mm范围的腱膜组织.然后稍加外力松解指关节周围的挛缩组织,使手指恢复伸直位.术后2周给予手指伸直位石膏托制动.结果 所有患者随访6～24个月.锯齿形皮瓣均存活,未见神经肌腱损伤并发症.手掌部皮瓣尖角出现血运障碍2例,经换药后完全愈合.未见手指屈曲挛缩复发,手指屈伸活动度恢复优良率100%.结论 采用锯齿状切口,应注意保护皮瓣血运和指神经血管束,彻底切除松解病变的腱膜组织,可有效矫正掌腱膜挛缩引起的手指屈曲畸形,避免并发症的发生.     

一期拇对掌功能重建结合多边形皮瓣治疗先天性铲状手畸形

目的探讨一期掌骨截骨、拇对掌功能重建结合多边形皮瓣治疗先天性铲状手畸形的临床疗效。方法 2013年1月—2017年3月收治铲状手畸形患儿8例。男5例,女3例;年龄13～35个月,平均17.5个月。患儿均表现为手指完全并指的"平板样"畸形,患手较健侧短小;所有对侧手均无异常,均未合并胸部、头颅、面部畸形。手术均采用掌骨截骨、拇指对掌功能重建并通过掌背矩形瓣重建虎口、多边形皮瓣旋转重建拇指指蹼及拇示指甲侧襞,拇指尺背侧及示指桡侧近节通过植皮修复。术后采用手功能评定专用游标卡尺测量患手虎口距离,拇指功能采取改良Tada评分评价。结果 8例患儿对掌功能重建与虎口成形均一期完成,术后拇指尺背侧及示指桡侧植皮均成活。患儿均获随访,随访时间13～29个月,平均16.1个月。术后无皮瓣坏死、拇指侧偏、虎口挛缩等并发症发生。末次随访时所有患儿虎口区皮肤颜色与健侧无明显区别;患手虎口开大距离3.5～5.0 cm,平均4.2 cm;术后拇指功能采用改良Tada评分,获优7例、良1例,优良率100%。术后拇指均可主动行抓握、对捏等动作,对掌功能良好。结论一期拇对掌功能重建结合多边形皮瓣治疗先天性铲状手畸形术后手部功能改善良好,皮瓣设计合理能有效覆盖重要区域,手术安全可靠。     

滨腱挛缩症的临床及病理基础

目的：探讨掌腱膜挛缩症的病理改变与疗效之间的的关系，为合理选择手术方式提供依据。方法：对２６例掌腱膜空症患者共２９只手进行手术治疗，其中１２只手单纯作滨腱膜切除术，１７只手行掌腱切除＋受累皮肤切除术，对其疗效进行平均４．６年的随访；并对２４例滨腱膜标本作病理学及免疫组化检测。结果：所有行免疫组化检测的病变掌腱膜标本中均有α－平滑肌肌动蛋白的表达；单纯掌腱膜切除组的术后复发率为５８．３３％，掌腱膜切     

应用外固定延长技术治疗虎口挛缩

目的 探讨应用外固定延长技术治疗虎口挛缩的手术方法及疗效.方法 2002年8月至2006年10月,使用外固定延长技术治疗虎口挛缩56例,40例有完整随访资料.男35例,女5例;年龄18～52岁,平均34岁;右手26例,左手14例.损伤原因:创伤性30例,烧伤性10例.依照顾玉东虎口挛缩分类方法(1986年):中度挛缩25例,重度挛缩15例.拇指再造后2例.方法采用局麻或臂丛神经阻滞麻醉,在第一、二掌骨颈附近打人固定针,于掌骨间安放B-46型Orthofix微型外固定架.术后次日开始延长,每天1mm,分早、晚两次进行,延长至固定架的最大限度,时间为3～4周.反复延长3次,后两次时间各为1周,最后维持在最大外展位2周.记录末次随访时虎口开大程度.结果 40例患者获得随访,随访时间3～6个月,平均4个月.掌侧拇外展角度平均增大20°,拇指指间关节尺侧和示指掌指关节桡侧间距平均增加2.5cm.术后5例出现针道感染,4例发生第一腕掌关节半脱位,4例发生近节指骨尺偏畸形.结论 使用外固定延长技术治疗虎口挛缩,方法简单,手术一次完成,治疗结果满意.     

先天性V型复拇指畸形的手术治疗体会

目的探讨先天性V型复拇指畸形的手术治疗方法及疗效。方法 2010年3月-2015年5月,收治12例先天性V型复拇指畸形患者。男7例,女5例;年龄1~25岁,平均8岁。左手4例,右手8例。桡侧为主型2例,尺侧为主型10例。7例赘生指基底远离腕掌关节,5例赘生指基底靠近腕掌关节(略尺偏1例)。X线片示主干拇指第1掌骨与大多角骨均对合良好,伴第1掌骨侧弯畸形2例。术前制定个体化治疗方案,作S形或Z形切口,切除赘生指,同时重建大鱼际肌止点或内收肌止点,必要时联合楔形截骨术矫形。结果术后患者切口均Ⅰ期愈合。术后12例均获随访,随访时间6~24个月,平均12个月。11例拇指外形、屈伸、对掌、外展功能均较术前改善,未出现瘢痕挛缩畸形、虎口区狭小及偏斜畸形等情况。1例虎口区略狭小,拇指外展不良,经再次"Z"字成形术后改善。末次随访时,根据中华医学会手外科分会上肢部分功能评定试用标准评定患指功能:优10例,良1例,差1例;优良率91.7%。结论根据V型复拇指畸形情况制定个体化手术方案,可较好恢复拇指外形及功能。     

显微外科方法治疗掌腱膜挛缩症的临床疗效分析

掌腱膜挛缩症多表现为单侧或双侧掌指关节、指间关节掌腱膜进行性屈曲挛缩,局部可触及串珠状、条索状结节[1].2005至2010年,我院共收治15例掌腱膜挛缩症患者,分别采用传统手术方法及显微镜下手术切除,术后疗效满意. 1.一般资料:本组15例,均为男性;年龄42～82岁,平均60岁.     

Dupuytren's contracture limited to the distal interphalangeal joint--a case report]

A case of Dupuytren's contracture involving only the distal interphalangeal joint of the right little finger is reported. The contracture developed gradually during 6 months, after a minor trauma of this finger. Distal phalanx was fixed in 60 degrees flexion in the distal and 30 degrees flexion in the proximal interphalangeal joints, but it did not disturbed patient's normal daily activity. Proximal interphalangeal flexion was easy reducible, but distal phalanx was settled in fixed flexion deformity. No pathology was seen in the palmar aspect of the midhand. At the exploration, a thickened 1 cm long cord localised at the radial side of the distal interphalangeal joint and extending across this joint was identified, and excised. This resulted in full correction of the flexion deformity. Histopathological examination revealed excised cord to be a fibrous tissue, typical for the Dupuytren's contracture.     

Palmar fascial complex anatomy and pathology in Dupuytren's disease

Familiarity with the normal palmar fascial anatomy of the hand is necessary for understanding the convoluted pathologic changes that take place in Dupuytren's disease. This article includes a literature review and the findings of a study by the author of the fascial anatomy and pathology as related to Dupuytren's disease. Gross and microdissection of the palmar fascial structures were carried out with the aid of the operative microscope and an arthroscope, which allowed examination of the fine and undisturbed retinacular anatomy. The palmar fascial complex of the hand has five components: the radial aponeurosis, ulnar aponeurosis, central (palmar) aponeurosis, palmo-digital fascia, and digital fascia. The subtle constituents of each component are outlined and the transformation from normal to pathologic anatomy is clarified.     

The septa of Legueu and Juvara: an anatomic study

PURPOSE: To study the anatomy of the septa of Legueu and Juvara and interpalmar plate ligaments (IPPLs) of the hand. MATERIALS: Eleven cadaver hands were dissected. The number, attachments, dimensions, and relationships of the septa and IPPLs to other structures were determined. RESULTS: Eight septa were identified radial and ulnar for each digit. The radial were longer than the ulnar septa. The septa attached to the transverse ligament of the palmar aponeurosis superficially and to the soft-tissue confluence deeper and distally. They formed 7 compartments of 2 types flexor septal canals that contained the flexor tendons and web space canals that contained common digital nerves and arteries and lumbrical muscles. Grossly and histologically the septa were thicker and consisted of organized collagen distally but not proximally. Three IPPLs were identified: radial, central, and ulnar. These formed the floors of the second, third, and fourth web space canals. The IPPLs were more substantial, thicker, and had more fibrous appearance from radial to ulnar. The fibers of the radial and central IPPLs were oriented transversely, whereas those of the ulnar IPPL were oriented obliquely. CONCLUSIONS: Awareness of the anatomy of deep retinacular structures of the hand is important for surgical exposure in this area and possible involvement in conditions such as Dupuytren's disease.     

Flap choices to treat complex severe postburn hand contracture

Many regions of the hand are affected seriously in the patients with complex severe postburn hand contractures. Multiple flap choices should be in count to treat complex severe postburn hand contractures affectively. We preferred dorsal ulnar flap for palmar region, cross-finger flap, side finger flap, and combined use of both for flexion contracture of the fingers, and rhomboid flap for web contractures. Eight patients having complex severe postburn hand contractures were treated between November 2001 and February 2005. The maximum improvements of the joint extensions were 75 degrees for median of digits metacarpophalangeal joint and 105 degrees for proximal interphalangeal joint. Grasp function of the hand dramatically improved, and the bulk of the flap did not interfere grasping. Complex severe postburn hand contracture can be treated sufficiently with dorsal ulnar flap, combined use of cross-finger and side finger transposition flap, and rhomboid flap.     

Venous anatomy of the thumb.

The venous anatomy of 20 thumbs (10 pairs) was detailed by latex injection. The thumbs were studied on the dorsal, palmar, radial, and ulnar surfaces. Characteristic patterns were found; these included a dominant longitudinal network, palmar veins within the pulp, oblique veins at the interphalangeal joint on the radial side, and a web space vein. A layered vascular pattern with a superficial fine network overlying a deeper system was noted. Cross sections were taken at the metacarpophalangeal joint and at the proximal and distal phalanges. The distribution of the vessels in cross section reveals consistent dorsal veins at all levels, as well as palmar veins distal to the interphalangeal joint in all thumbs. Palmar veins were present over the length of the proximal phalanx in more than 65% of the thumbs.     

Pathologic anatomy.

The typical case shows one or more thickened bands overlying the flexor tendons in the palm that connect with one another via the transverse palmar fascia. Vertical septae fix the bands securely to the underlying fascia and transverse metacarpal ligaments. These septae pass deep between the tendon and neurovascular tunnel. Bands running into the fingers represent thickening and fibrosis of the natatory ligaments. Typically, a central band continues into the finger, forks, and dissipates just distal to the PIP joint. This dissipation occurs with bifurcation of the central band into two thickened bundles that pass deep to the neurovascular bundle and attach to the flexor sheath of the middle phalanx. There are also thickenings of Grayson's ligaments that run from the central cord laterally and dorsally. Understanding the anatomy of the palmar aponeurosis is essential to the effective treatment of Dupuytren's contracture. Because the cause is unknown, treatment is best directed at anatomic deformities. Although not systemic or lethal, poorly treated Dupuytren's contracture can lead to significant morbidity and long-term disability. The palmar aponeurosis and its substructures are more than just passive barriers. They integrate hand parts and when pathologically fibrosed can contract joints, deform skin, and deviate neurovascular structures. The best treatments are recognition of the contracture, meticulous dissection, and local radical fasciectomy. Special attention is directed toward protecting spiralling neurovascular bundles. Difficult releases are enhanced by judicious release of checkreins, tendon sheath attachments, and disease on the radial side of the hand.     

Dupuytren's disease on the radial aspect of the hand: report on 135 hands in Japanese patients

We studied 135 hands in 77 Japanese patients to assess the frequency of radial involvement and its association with recurrence and the Dupuytren's diathesis. The radial aspect of the hand was affected in 22% of the hands. Diseased cords were observed in ten patients who underwent surgery on the radial aspect of the hand. Longitudinal cords on the radial side of thenar eminence and distal transverse interdigital cords were common. The radial aspect of the hand was the most common site of disease extension, though recurrence never occurred after excision of a radial lesion. Ectopic lesions, bilateral hand involvement, and recurrence were significantly more frequent in patients with the radial side involvement. Thus the results of this study suggest that radial side disease is associated with the Dupuytren's diathesis and is a risk factor of recurrence.     

The proximal interphalangeal joint in Dupuytren''s disease

In one hundred patients with Dupuytren's disease, one hundred and fifty-four operations were performed. The average pre-operative proximal interphalangeal joint contracture was 42 degrees and the average percentage improvement in proximal interphalangeal joint extension at post-operative review was 41%. Fourteen amputations were performed (9.1%). The primary deformity is caused by disease involvement of the palmar fascial structures. Secondary changes may prevent correction of the deformity despite excision of the contracted fascia. The anatomy of the joint is reviewed together with the primary and secondary mechanisms of joint contracture in Dupuytren's disease. Arthrodesis, osteotomy of the proximal phalanx and joint replacement are considered as alternatives to amputation when a systematic surgical approach fails to correct the flexion contracture.     

Surgery for Dupuytren's disease in Japanese patients and a new preoperative classification

The surgical outcome of Dupuytren's disease was evaluated in 73 hands of 57 patients in a Japanese population. Subtotal fasciectomy was performed in all cases. Surgical results were evaluated using the percentage improvement of extension in each finger joint. Statistical analyses were performed on the risk factors associated with recurrence and extension. The surgical outcome depended on the degree of contracture of the proximal interphalangeal joint. Recurrence of disease occurred in eight patients (14%) and extension occurred in nine (16%). Recurrence and extension frequently occurred in those who had ectopic lesions or involvement of the radial side of the hand. The present results suggested that the Dupuytren's diathesis had an influence on recurrence and extension. We proposed a new classification of Dupuytren's disease that might help to predict the surgical outcome and facilitate surgical planning.