断掌腕再植术后手内在肌挛缩的原因及防治措施

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好４例,中５例,手内在肌阳性

THE PATHOGENIC MECHANISM AND PREVENTION AND TREATMENT OF MUSCLE CONTRACTURE AFTER REPLANTATION OF SEVERED PALM OR WRIST

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.