残存指异位再植重建拇指功能

目的 应用残存指异位再植重建拇指,并观察其疗效.方法 对17例拇、手指毁损伤并皮肤缺损者,将残存指异位再植至拇指位置,同时行皮瓣移植修复虎口及皮肤缺损创面,重建拇指功能.术后进行系统的康复锻炼.结果 17例异位再植指全部存活.术后随访1～5年,手功能恢复按中华医学会手外科学会上肢部分功能评定试用标准评定:优3例,良11例,可3例;优良率为82.4%.结论 利用残存指异位再植的方法重建拇指功能,术后获得了良好的效果.     

掌板关节囊松解术治疗压砸伤术后掌指关节屈曲障碍

Objective To discuss the application of volar plate joint capsule release to treat metacarpophalangeal joint flexion contracture caused by severe crush injury to the palm. Methods From September 2005 to June 2008, 8 cases with post-traumatic metacarpophalangcal joint flexion contracture caused by severe crush injury was treated with volar plate joint capsule release. Postoperatively the patients underwent keritherapy and functional exercise. They were followed up to evaluate recovery of metacarpopha]angeal joint flexion. Results All 8 patients had metacarpophalangeal joint flexion contracture of the middle finger. The joint flexion function was improved remarkably after the surgery. The joint movement limitation decreased to 0° to30°and the functional impairment reduced to 0% to 18%. Conclusion V olar plate joint capsule release is an excenent method to treat metacarpophalangeal joint flexion eontraeture caused by severe palm crush injuiy. It is easy to operate and leads to reliable results.     

病理性瘢痕组织中CyclinD1、CyclinE和P21WAF1蛋白的表达及意义

目的:探讨cyclinD1、cyclinE和p21WAF1蛋白在病理性瘢痕中的表达及意义。方法:采用免疫组化SP法检测30例人病理性瘢痕组织、20例普通瘢痕组织和18例正常皮肤组织中cyclinD1,cyclinE和p21WAF1蛋白的表达情况。结果:cyclinD1、cyclinE和p21WAF1蛋白在病理性瘢痕中的表达与在普通瘢痕组织和正常皮肤组织中的表达有显著性差异(P<0.05),且cyclinD1与cyclinE,p21WAF1蛋白的表达成正相关(P<0.05),cyclinE与p21WAF1蛋白的表达无关(P>0.05)。结论:cyclinD1、cyclinE和p21WAF1蛋白的过表达及相互作用可能参与病理性瘢痕的形成过程。     

掌板关节囊松解术治疗压砸伤术后掌指关节屈曲障碍

Objective To discuss the application of volar plate joint capsule release to treat metacarpophalangeal joint flexion contracture caused by severe crush injury to the palm. Methods From September 2005 to June 2008, 8 cases with post-traumatic metacarpophalangcal joint flexion contracture caused by severe crush injury was treated with volar plate joint capsule release. Postoperatively the patients underwent keritherapy and functional exercise. They were followed up to evaluate recovery of metacarpopha]angeal joint flexion. Results All 8 patients had metacarpophalangeal joint flexion contracture of the middle finger. The joint flexion function was improved remarkably after the surgery. The joint movement limitation decreased to 0° to30°and the functional impairment reduced to 0% to 18%. Conclusion V olar plate joint capsule release is an excenent method to treat metacarpophalangeal joint flexion eontraeture caused by severe palm crush injuiy. It is easy to operate and leads to reliable results.     

双前臂残端断指异位再植重建部分手功能一例

患者男,18岁,工人.因机器压伤致双前臂远端、腕掌部毁损伤1 h入院.检查:双前臂远端、腕掌部及双拇指、示指近节皮肤软组织严重挫伤碎裂,桡、尺骨远端、腕掌骨及拇指指骨均呈粉碎开放性骨折脱位,双侧中、环、小指相对完好但无血运,其中右环、小指指蹼尚完整,右小指掌尺侧有一宽约1.5cm 皮肤软组织与前臂相连(图1,2).     

掌板关节囊松解术治疗压砸伤术后掌指关节屈曲障碍

目的 探讨应用掌板关节囊松解术治疗手掌严重压砸伤造成的掌指关节屈曲障碍.方法 2005年9月-2008年6月,应用掌板关节囊松解术治疗8例严重压砸伤术后掌指关节被动屈曲障碍的患者,并进行随访,结合蜡疗及功能锻炼观察掌指关节屈曲功能的恢复情况.结果 8例患者均为第3掌指关节被动屈曲障碍,术后关节屈曲功能均获明显改善.屈曲失能角度(F)减小,达到0°～30°;失能值降低,达到0%～18%.结论 应用掌板关节囊松解术治疗手掌严重压砸伤造成的掌指关节屈曲障碍,是一种操作简便、疗效可靠的良好方法.     

屈拇长肌腱Ⅱ区断裂的围手术期康复治疗

目的以30例屈拇长肌腱Ⅱ区断裂一期治愈的忠者为例,阐述屈拇长肌腱损伤的围手术期康复治疗。方法2001年3月～2006年3月,对30例屈拇长肌腱Ⅱ区断裂患者采用双套圈交叉6股屈肌腱缝合法修复及石膏外固定。术后按照肌腱生物力学性能变化规律,在医师指导控制下进行功能训练。结果术后所有患者获得6～16周(平均8周)随访,按TAM评定标准评价疗效：优12例,良10例,中6例,差2例,优良率为73．3%。功能达到优良的22例患者术后16周能用患指完成持笔写字、扣纽扣及拿筷子等日常生活动作。无患者出现二次断裂。结论正确的术前诊断,术中无创伤和牢固的缝合技术,术后安全的外固定,按照肌腱愈合的生物力学改变特点,在医师指导控制下进行功能训练,是屈拇长肌腱Ⅱ区断裂一期治愈的关键。     

掌板关节囊松解术治疗压砸伤术后掌指关节屈曲障碍

Objective To discuss the application of volar plate joint capsule release to treat metacarpophalangeal joint flexion contracture caused by severe crush injury to the palm. Methods From September 2005 to June 2008, 8 cases with post-traumatic metacarpophalangcal joint flexion contracture caused by severe crush injury was treated with volar plate joint capsule release. Postoperatively the patients underwent keritherapy and functional exercise. They were followed up to evaluate recovery of metacarpopha]angeal joint flexion. Results All 8 patients had metacarpophalangeal joint flexion contracture of the middle finger. The joint flexion function was improved remarkably after the surgery. The joint movement limitation decreased to 0° to30°and the functional impairment reduced to 0% to 18%. Conclusion V olar plate joint capsule release is an excenent method to treat metacarpophalangeal joint flexion eontraeture caused by severe palm crush injuiy. It is easy to operate and leads to reliable results.     

手掌压砸伤术后尺偏手畸形的病因及治疗

目的 探讨手掌压砸伤术后"尺偏手"畸形的形成原因和治疗方法.方法 对40具手标本通过测量各指指背腱膜相对于指骨的位置、手内在肌的重量及生理横切面积,为明确临床"尺偏手"畸形的病因提供解剖学研究基础.2007年3月至2010年2月,对6例严重手压砸伤造成术后"尺偏手"畸形的患者进行手内在肌功能重建术.结果 解剖学研究发现指背腱膜及伸肌腱有将掌指关节拉向尺侧的作用力,而手内在肌则与之对抗,形成向桡侧的作用力.在正常手中,这两种作用力是平衡的;而在压砸伤术后手内在肌缺损的情况下,就失去了向桡侧的作用力,导致了临床中常见的"尺偏手"畸形.6例"尺偏手"畸形手内在肌功能重建术后随访时间平均8.5个月,尺偏得到较好的纠正,拇对指功能得到明显改善.结论 严重手掌压砸伤术后因手内在肌缺损导致肌力失衡引起"尺偏手"畸形,应在急诊手术中尽量保留手内在肌的连续性并修复断裂的手内在肌;对已经形成的"尺偏手"畸形,需行手内在肌重建术.

Abstract：

Objective To investigate the cause and management of ulnar club-hand secondary to crush injury of the palm. Methods Forty eadaver hands were dissected to measure the relative position between extensor aponeurosis and phalanges, the weight and cross-sectional area of intrinsic muscles to provide anatomical basis of the causes of ulnar club-hand. From March 2007 to February 2010, six patients with ulnar club-hand secondary to severe crush injury underwent intrinsic muscle reconstruction. The causes of ulnar club-hand were investigated in these cases. Results Anatomical dissection revealed that the extensor aponeurosis and extensor tendon of the finger tend to deviate the metacarpophalangeal joint ulnarly, while the intrinsic muscles work antagonistically to pull the joint radially. In the normal hand, these two kinds of acting forces are balanced. In the absence of intrinsic muscles after severe crush injury of the hand, this balance is broken, and the hand tends to deviate ulnarly. Intrinsic muscle reconstruction in six patients with ulnar club-hand secondary to palm crush injury restored the balance and corrected the ulnar deviation deformity after 8.5 months follow-up. Thumb opposition was also improved. Conclusion The absence of hand intrinsic muscles was the main cause of ulnar club-hand in severe crush injury. In the emergency operation, ruptured intrinsic muscles should be repaired whenever possible to prevent ulnar club-hand. For established ulnar club-hand, intrinsic muscle reconstruction should be done to correct the deformity.     

仅吻合指端动脉弓分支指尖离断再植

目的报道仅吻合指端动脉弓分支指尖离断再植的临床效果。方法对24例无可供吻合静脉的甲中段以远指尖离断，应用仅吻合指端动脉弓分支的方法再植，术后不常规行小切口或拔甲放血。结果成活22例，成活率为91．6％。随访6-24个月，再植指指体饱满，两点辨别觉4-7mm，外观及功能满意。结论甲中段以远指尖离断，仅吻合指端动脉弓分支再植术后效果良好。