中度前臂缺血性肌挛缩早、晚期手术治疗的临床观察

目的探讨中度前臂缺血性肌挛缩早、晚期手术治疗的疗效分析。方法1997—2003年，对中度前臂缺血性肌挛缩25例早期患者采取神经、肌肉松解减压术，对其中6例行肌腱移位、延长、屈肌起点滑移术。25例晚期患者采取神经、肌肉松解减压和肌腱移位、延长、屈肌起点滑移等手术。结果术后随访1—5年，早期手术组手功能恢复：优11例，良8例，可6例，优良率为76％。晚期手术组：优6例，良6例，可11例，差2例，优良率为48％。早期手术组术后肌电神经传导速度显示正中、尺神经恢复明显优于晚期手术组。结论中度前臂缺血性肌挛缩早期手术治疗，对促进前臂神经、手内在肌功能和保护性感觉的恢复、防止关节挛缩等均有较好的疗效。     

分期手术治疗中晚期前臂缺血性肌挛缩

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。     

前臂缺血性挛缩的手术治疗

目的：探讨前臂缺血性肌挛缩不同时机手术疗效和最佳手术时机。方法：早期手术组（病程3周以内）4例行坏死肌肉切除、筋膜切开减压，肌腱移位，其中2例行带蒂背阔肌皮瓣移位。晚期手术组（病程6周以上）6例行肌肉（腱）松解、屈肌止点下移、神经松解或移植、肌腱移位延长。其中4例行带蒂背阔肌皮瓣移位，1例行吻合血管神经的游离股薄肌移植重建屈指功能。结果：随访10例，时间2－6．5年。早期手术组优3例，良1例。晚期手术组良3例，差3例。结论：前臂缺血性肌挛缩早期手术能够有效解除组织缺血，防止挛缩纤维化，减轻神经压迫的损害，有利于手功能的恢复。     

前臂缺血性肌挛缩的早期外科治疗远期随访分析

目的 探讨前臂缺血性肌挛缩早期显微外科治疗的临床意义及治疗效果。方法 应用显微外科技术早期为28例1病程为1．5～9个月的前臂缺血性肌挛缩患者行神经、肌腱松解术。结果 术后2～15年系统随访，其优良率为82％。手的外形及运动和感觉功能得到了良好的恢复。结论 前臂缺血性肌挛缩早期显微外科治疗是可行性。     

前臂缺血性肌挛缩的临床治疗

目的 报道前臂缺血性肌挛缩的临床治疗和早期预防.方法 10例急性期行切开探查减压、引流、松解、修复积极处理;6例挛缩期的患者行减压、松解、肌肉动力学替代修复重建和减压、松解＋屈指深、浅肌腱交叉延长术治疗;1例晚期重度前臂缺血性肌挛缩行肌腱（肉）、神经松解、止点滑移、肌腱交叉延长矫正畸形、重建功能.结果 10例急性期、6例挛缩期获得良好的临床疗效;1例晚期重度前臂缺血性肌挛缩行多种方法 联合畸形矫正、功能重建,疗效较差.结论 前臂缺血性肌挛缩早期能够得到积极有效的防治,可获得较为满意疗效,延误治疗,后期很难获得满意的疗效.     

中重度前臂缺血性肌肉挛缩晚期功能重建的手术治疗

目的 探讨中、重度前臂缺血性肌肉挛缩晚期功能重建的手术方法及疗效。方法 对42例中、重度前臂缺血性肌肉挛缩的晚期患者，进行旋前畸形矫正和旋后对掌功能重建手术。其中6例行指浅、深屈肌腱交叉延长术，17例行肌腱转位术＋骨间膜、旋前方肌松解术，19例行肌腱转位术＋骨间膜、旋前方肌松解术＋腕屈肌旋后功能重建术。结果 术后42例患者均获得6～34个月的随访。旋后功能恢复：优9例，良18例，可12例，差3例，优良率为64．3％。手功能恢复：优11例，良15例，可14例，差2例，优良率为61．9％。结论 对中、重度晚期缺血性肌肉挛缩的患者，应针对其不同的挛缩程度采用不同的手术方法进行治疗。     

幼儿前臂肌肉缺血性挛缩的显微外科治疗

幼儿晚期前臂肌肉缺血性挛缩一直是临床治疗中的难题。我们利用显微外科技术切除变性肌肉、松解正中神经和尺神经,前臂屈肌群起点下移等手术,对5例幼儿晚期中、重度前臂肌肉缺血性挛缩进行治疗,取得了比较满意的疗效。一、资料与方法1.本组共5例,男3例,女2例;年龄2～5岁。损伤原因:上肢桡骨骨折3例,尺骨骨折1例,肱骨髁上骨折1例。5例均作闭合复位加石膏托外固定。固定时间为1～2个月。待去除石膏托后发现患儿继发前臂缺血性挛缩,属中、重度挛缩。病程:最长1.5年,最短6个月,平均1年2个月。2.手术方法:全麻后作前臂长“S”形切口,暴露屈肌和…     

广泛神经松解术治疗儿童中晚期前臂缺血性肌挛缩的疗效分析

目的评估广泛神经松解术治疗儿童中晚期前臂缺血性肌挛缩的疗效, 并探讨手术时机。方法自2014年1月至2019年12月我院收治14例中晚期缺血性肌挛缩患儿, 依据受伤至手术时间分为中组期7例、晚期组7例, Tsuge中型9例、重型5例。患者均一期采用广泛神经松解术治疗。根据肌电图结果、手功能恢复情况评估手术效果。结果 14例患儿术后随访时间3～6个月, 平均(3.9±1.0)个月。肌电图(EMG)显示, 治疗前两组患儿正中神经、尺神经神经传导速度(MCV)、潜伏期(LAT)、传导波幅(AMP)差异均无统计学意义(P>0.05);比较两组术后正中神经、尺神经MCV、LAT及AMP改善程度, 中期组正中神经潜伏期较晚期组改善明显, 尺神经传导速度中期组较晚期组改善明显, 差异均有统计学意义(P<0.05);ECG手内在肌募集相显示, 中期治疗组患儿手内在肌好转率明显高于晚期组;根据中华医学会手外科学会上肢部分功能评定试用标准, 中期组、晚期组术后功能评价优良率分别为100%和71.4%。术前14例患儿均无法完成拇对掌及夹纸动作或完成重度受限, 术后随访9例恢复拇对掌动作, 8例恢...     

肌腱转移术治疗前臂背侧缺血性肌挛缩

目的总结肌腱转移术治疗前臂背侧缺血性肌挛缩的疗效。方法 2003年3月-2010年9月,采用坏死组织切除、肌腱神经松解结合屈肌腱转移术治疗7例前臂背侧缺血性肌挛缩。男5例,女2例;年龄6～36岁,平均18.5岁。病程6～15个月。患者伸指及伸腕功能障碍,肌力0～2级,总主动活动度(total active movement,TAM)为80～130°。结果术后患者切口均Ⅰ期愈合。患者均获随访,随访时间1～4年,平均2.2年。末次随访时,伸指、伸腕功能明显改善,肌力3～4级,TAM为150～260°;获优3例,良3例,可1例,优良率为85.7%。结论应用坏死组织切除、肌腱神经松解结合屈肌腱转移术治疗前臂背侧缺血性肌挛缩效果良好。     

逆行肌肉松解法治疗轻中型前臂缺血性肌挛缩

目的 探讨逆行肌肉松解法治疗Tsuge 分型为轻、中型前臂缺血性肌挛缩的临床效果.方法 2010 年3 月-2018 年9 月,采用逆行肌肉松解法治疗11 例轻、中型前臂缺血性肌挛缩患者.男6 例,女5 例;年龄16～29 岁,平均24 岁.按照Tsuge分型,轻型6例、中型5 例.受伤至手术时间9 个月～25 年,中...     

前臂缺血性肌挛缩的康复治疗

叙述前臂缺血性肌挛缩康复治疗的方法、疗效及其与预后的关系。方法:对20例前臂缺血性肌挛缩进行局部创面处理后,以强化热疗法、低中频电疗、运动疗法、作业疗法、感觉训练和使用夹板支具等手段行康复治疗。治疗时间1个月～1年,平均为7.2个月。结果:20例中,疗效优者(S_4M_5)7例,良(S_3M_4)4例,可(S_2M_3)9例,优良率为55％。结论:前臂缺血性肌挛缩的预后主要和损伤程度、治疗时间及是否作康复治疗有密切的关系。及时有效的康复治疗可以促使缺血性肌挛缩的病理过程向好的方面转归,减少并发症的发生。     

Results of the Max Page muscle sliding operation for the treatment of Volkmann’s ischemic contracture of the forearm

Background

Volkmann’s ischemic contracture is a less common but crippling condition affecting the extremities. Once the condition sets in, the prognosis always remains guarded, even after long and intensive physiotherapy and various restorative surgical techniques. This study was undertaken to evaluate the long-term functional results of the Max Page muscle slide operation in patients with Volkmann’s ischemic contracture of the forearm of moderate degree (Tsuge classification).

Materials and methods

Nineteen patients treated between 1997 and 2009 were evaluated. The functional outcome (measured as the dexterity score, hand grip strength, sensibility, and appearance) was analyzed postoperatively. The pre- and postoperative values were compared using a paired t test. The final results were graded as good, fair, and poor.

Results

The average age at the time of presentation was 18 years (range 3–25 years). Tight external splintage for injuries around elbow and forearm was the primary factor. The mean period of follow-up was 3.53 years. Fifteen patients were able to achieve good functional results. Three had fair and one had poor results. All three variables showed significant improvements postoperatively. Wound dehiscence was the most common complication. One patient needed a second surgery to restore good hand function.

Conclusion

The Max Page muscle sliding operation to treat Volkmann’s ischemic contracture of moderate degree gives good functional results. The procedure is simple and easy to perform. Adequate muscle release and proper postoperative physiotherapy are key to achieving good results.     

肌滑移术治疗前臂缺血性肌挛缩的疗效分析

目的：探讨肌滑移术治疗前臂Volkmann缺血性肌挛缩的疗效,方法：对32例前臂Volkmann缺血性肌挛缩者分为单纯型和复合型,采用单纯肌滑移术,肌滑移术加骨性手术,肌滑移术加神经内松解术。结果：29例得到随访,优良率为93．7％,结论：肌滑移术疗效可靠,对复合型病例可同时施行骨性手术或神经内松解术。     

Management of established Volkmann's contracture of the forearm in children

As with many diagnoses in medicine, the best treatment for Volkmann's ischemic contracture is prevention. Early recognition and prompt treatment of impending Volkmann's ischemia should decrease the presentation and severity of late contracture and hand dysfunction. The authors have found the flexor muscle slide the best treatment option for mild and moderate deformity. This procedure can be combined with additional reconstructive procedures to maximize functional outcome. The authors believe this procedure results in the best preservation of the muscle resting length and limits the scarring around the adjacent muscles. For severe cases,early wide excision with functional free-muscle transfer may limit the injury to the nerves, decreasing the distal problems associated with mo-tor and sensory impairment in the hand.     

FREE MUSCLE TRANSFER

Eight cases of free muscle transfer with the use of microsurgical technique are reported, comprising five patients with Volkmann's contracture of the forearm, two with poliomyelitis, and one with an old brachial plexus injury. Operation was successful in the six patients with traumatic injuries, but proved unsuccessful in the two with poliomyelitis. Generally, the vessels and nerves of the recipient site were anastomosed with their counterparts in the grafted muscle. In one patient with an old brachial plexus paralysis in whom nerves in the recipient site could not be used, muscle graft and intercostal nerve transfer procedures were employed. In six cases, only muscle was transferred, and in two cases, the muscle together with an overlying skin flap was removed to reduce tension of the skin at the recipient site.     

断腕再植术后手内在肌挛缩

探讨断腕再植术后手内在肌挛缩的发生率、治疗方法及预防。方法:作者总结了近24年内进行断腕再植并得到随访的63例资料,对其中发生手内在肌挛缩41例的发病机理、治疗结果及预防进行了分析和讨论。结果:63例断腕再植术后有41例发生手内在肌挛缩,发生率为65％。缺血时间超过16小时与16小时内的断腕再植术后手内在肌挛缩的发生率,两者差异有显著性意义(t=3.81,p<0.05)。二期行手内在肌手术矫正者效果不理想。结论:断腕再植术后手内在肌挛缩的处理关键在于预防。清创后用肝素化全血对离断手进行灌注,早期行手内在肌筋膜间区减压,将会取得较好的效果。     

Technical considerations and outcome of free functioning gracilis muscle transfer for finger flexion in patients with Volkmann's Ischemic Contracture

IntroductionSevere Volkmann's Ischemic Contracture (VIC) is a reconstructive challenge for the surgeon because of the loss of entire flexor muscle mass and lack of powerful wrist extensors for restoration of finger flexion. In such cases, free functioning muscle transfer (FFMT) using gracilis is our choice. We herein summarize the technical considerations to achieve a successful outcome and report functional outcome achieved in our series.Patients and MethodBetween 2007-2018, 22 patients of VIC underwent gracilis FFMT for restoration of finger flexion. FFMT was done as a second stage following an initial stage of neurolysis/excision of fibrotic flexor muscles/contracture release/flap cover in these patients. Cases were retrospectively reviewed and their functional outcome at a minimum of one-year follow up was analyzed. Follow-up duration ranged from 2-13 years (average-4 years). At the final follow up, the motor and sensory recovery was evaluated using the Medical Research Council Grading and their function using Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsThe average age at surgery ranged from 3-45 years (average-18.4 years). All the transferred muscles survived. Secondary procedures to further improve the hand function were done in nine patients. The motor recovery for finger flexion was graded as M2 in two, M3 in nine and M4 in 11 cases. These 20/22 patients who recovered M3/M4 finger flexion expressed high satisfaction with the operation while other two also felt that they were better after the surgery. DASH score was available for 13 patients and it averaged 13.21 (Range-1.8-34.5). Grip strength was available for 10/22 patients and it averaged 10.5 kg (range-0-21kg) amounting to 24% of the normal side. The sensory recovery was graded as S4 in two, S3 in 17 and S2 in three cases.ConclusionGracilis FFMT is a reliable option for restoration of finger flexion in patients with severe VIC. Outcome is better when done after an early preliminary stage of excision of fibrosed muscles and neurolysis which allows recovery of intrinsic function and sensation. FFMT is best carried out 3-6 months after the first stage with supple skin and good passive range of movement in the fingers.