Volkmann's ischemic contracture

Volkmann's ischemic contracture is a complex process that often results in a significant functional disability. Destruction of the forearm musculature can, in certain situations, be reconstructed utilizing muscle transplantation. Proper patient selection, attention to detail at the time of the surgical procedures, and patient compliance during rehabilitation are key factors in a successful outcome. Functional results have been very rewarding, although certain problem areas await resolution.     

曲美它嗪对大鼠心肌缺血挛缩的保护作用

目的　探讨曲美它嗪 (TMZ)对心肌缺血挛缩的保护作用。方法　大鼠分为A、B、C、D4组 ,A为对照组 ,微流量灌注 (0～ 1ml/min)制成心肌缺血模型 ,实验前口服曲美它嗪 (3mg/d× 7d) ,灌流液中加入 1× 10 -6mol/L的TMZ ,观察缺血后心脏发展压力的变化。结果　口服曲美它嗪、灌流液中添加曲美它嗪组与对照组相比 ,心肌缺血后发展压力有明显改善。缺血 30min时 ,A组 :(4 .49± 0 .6 0 )kPa(1kPa =0 .75mmHg) ;D组 :(1.39± 0 .75 )kPa ,差异有非常显著性 (P <0 .0 1)。再灌注 15min时 ,A组 :(4 .2 8± 0 .77)kPa ;D组 :(1.36± 0 .2 7)kPa ,差异有非常显著性 (P <0 .0 1)。缺血后发展压力恢复率在复灌后 5min内明显改善 ,A组 :(74.3± 8.4) % ,D组 :(98.6± 3.2 ) % ,差异有非常显著性 (P <0 .0 1)。结论　曲美它嗪对心肌缺血挛缩有明显的保护作用。     

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。     

Volkmann's ischemic contracture. Prevention and treatment

It may be concluded that treatment of patients with Volkmann's ischemic contracture is complicated and depends on a number of different variables. Optimal treatment of an established contracture requires a through examination of the extent of damage of the ischemia, followed by conservative therapy or operation. The most important measures concerning Volkmann's ischemic contracture, however, involve measures to prevent the contracture. It is poignant that very simple measures, such as monitoring high-risk injuries and immediate vascular repair or decompression if symptoms of a compartment syndrome are present, can prevent this disabling condition. The following summaries hopefully provide guidelines for prevention and treatment of Volkmann's ischemic contracture.     

Congenital Volkmann-Lesser ischemic contracture of the upper limb

Neonatal vascular compromise to limbs has been associated traditionally with perinatal injury of the brachial plexus, fracture of the clavicle or humerus, or iatrogenic causes. Congenital Volkmann's ischemic contracture is an exceptional etiology of ischemic limb in the newborn. Fewer than 10 cases had been described in the literature. The authors report a newborn presenting at birth with partial bluish discoloration of the right forearm. The clinical picture and laboratory studies lead to the diagnosis of congenital Volkmann-Lesser ischemic contracture.     

Effects of low extracellular calcium on cytosolic calcium and ischemic contracture

We have shown that myocardial cytosolic calcium [Cai] rises during ischemia. Simultaneously membrane bound stores are depleted. The [Cai] rise precedes the onset of irreversible ischemic contracture. We found that a low extracellular calcium [Cao] (100 microM) perfusate decreased peak contracture pressure and delayed the time to onset and to peak of ischemic contracture in the isolated retroperfused rabbit heart subjected to 37 degrees C ischemia. [Cai] was measured with the intracellular [Cai] fluorescent indicator Fura-2 AM (10 microM) in a separate group. In the group exposed to 2.45 mM Ca2+ there was a significant rise (P less than 0.05) in [Cai] to above 50% of preischemic value after 30 min of ischemia. The [Cai] in the low [Cao] perfused group at 30 min of ischemia was 30% below the preischemic value. The peak of the [Cai] rise in the low [Cao] perfusate group was markedly attenuated and delayed to 40 min. Taken together it appears that low calcium perfusate (100 microM) prior to ischemia attenuates the ischemia-induced [Cai] rise, delays the onset, and decreases the force of contracture with irreversible ischemic injury.     

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.     

Functional reconstruction of ischemic contracture in the lower limb

Objective: To discuss the method of functional reconstruction of ischemic contracture in the lower limb and propose a classification protocol for ischemic contracture in the lower limb based on its severity and prognosis.Methods: Atotal of 42 patients with ischemic contracture in the lower limb were included in this study. According to different types of disturbance and degrees of severity,surgical reconstructions consisting of nerve decompression,tendon lengthening or transfer, intrinsic foot muscle release and sural-tibial nerve anastomosis were performed in every patient.Results: Postoperatively, all patients were able to walk on flat ground. Drop foot was corrected in 10 patients,and 5 patients still felt some difficulty during stair activity.Split Achilles tendon transfer to flexor hallucis longus tendon was performed in 12 patients, and their walking stability was improved. Seven patients accepted ipsilateral suraltibial nerve anastomosis, and sensitivity recovery reached to S2 in 2 patients and S3 in 5 patients.Conclusions: Ischemic contracture in the lower limb is a devastating complication after lower limb trauma. The prevention of contracture is much more important than the treatment of an established contracture. Split Achilles tendon transfer to flexor hallucis longus tendon and sural-tibial nerve anastomosis, which was initially implemented by us, could improve the functional recovery of ischemic contracture in lower limbs, and thus provides a new alternative for functional reconstruction of ischemic contracture in the lower limb.     

Clinico-roentgenological characteristics of the changes in ischemic Volkmann's contracture

In the article is presented the study of clinical aspects and roentgenograms of 91 children with Volkmann's contraction. The causes of contraction with 46 patients were supracondylar fractures of arm and with 32--forearm bone fractures. All fractures were associated with massive injures of soft tissues, some of the persons have injures of brachial artery. Tardy or incompletely dissected circular plaster bandage turned out to be a factor of complication. All patients demonstrated typical clinical aspects of acute circulatory disturbance of extremity, in some of them with skin and subcutaneous fat necrosis. Clinical aspects of contraction during residual period were notable for variety of manifestations and depended upon the depth of tissue affection (muscles, tendons, articulations, vessels, bones). The gravity of disease has been aggravated by affection of nerve trunks (66 patients). Roentgenologic picture revealed changes of mutual positioning of articular ends of jointed bones and trophic changes within the bones. Trophic changes were revealed by osteoporosis of different extent, growth disturbances as well as perversion of ossification rate of epiphysis and apophysis of tubular and carpal bones.     

Volkmann's ischemic contracture due to soft tissue injury alone.

Fifteen upper extremities, in 14 patients in whom incipient or actual Volkmann's ischemic contracture was present, were seen in a 5 year period. Nine patients were stuporous due to drug overdose and had laid on the extremity; two had received a recent injury of main arterial trunks; two had sudden severe compression; one with chronic myelogenous leukemia had each arm involved at different times in a bizarre autoimmune response causing massive swelling. No patient had a fracture or dislocation. Pain and tenderness, loss of sensibility, resistant muscle contracture, and rock-hard muscle compartments were warning signs. Immediate fasciotomy was done. Useful function was restored when treatment was carried out in the early stages of the ischemia.