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.     

改良指背筋膜蒂逆行岛状皮瓣修复指端皮肤缺损

目的探讨改良指背筋膜蒂逆行岛状皮瓣修复指端皮肤缺损的疗效及临床分析。方法切取指背筋膜蒂皮瓣时,皮瓣近端预留一条长1～2cm指背静脉,皮瓣切取后,松开止血带,温盐水复温,皮瓣蒂部局部应用罂粟碱解痉,观察并判断皮瓣供血与回流情况。若皮瓣出现血供不足,通过皮瓣内预留指背静脉与指动脉断端吻合,形成静脉动脉化皮瓣（10例）;若皮瓣出现静脉回流障碍,则将皮瓣内指背静脉与受区皮下静脉吻合,改善其回流（12例）;若皮瓣供血与回流基本平衡,则无需进行血管吻合（13例）。结果临床应用改良的指背筋膜蒂皮瓣修复指端皮肤缺损35例,皮瓣面积：1．2cm×1．6cm-2．7cm×3．2cm,其中辅助吻合预留血管22例,辅助血管吻合率63％,皮瓣全部成活。术后72h除静脉动脉化皮瓣有3例出现张力性水疱外．其余病例伤口均一期愈合,皮瓣供区植皮成活。术后随访6～18个月,平均9个月,手指功能与外观均满意,皮瓣质地良好,指端饱满,无触压痛。结论传统指背筋膜蒂逆行岛状皮瓣经选择性辅助吻合血管处理,其成活率和成活质量均有明显改善。     

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.     

砪趾C形皮瓣修复手指皮肤缺损

手部皮肤缺损为手外科常见的外伤之一,约有1/3的患者需行皮肤移植术[1].特别是当手指皮肤出现"C"形缺损时,临床处理较为困难.自2006年3月以来,我院对7例手指皮肤"C"形缺损的患者,采用MU砪趾"C"形皮瓣游离移植修复,术后皮瓣全部存活.     

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.     

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.     

指动脉静脉化在末节断指再植中的临床应用

目的 探讨指动脉静脉化在末节断指再植中解决静脉回流的临床应用. 方法 对26例30指末节离断进行再植,常规吻合1侧优势指动脉及双侧指神经,将远端另一侧非优势动脉与掌侧近端静脉吻合使远端一侧动脉静脉化解决静脉回流. 结果 成活27指,坏死3指,成活率90％.术后随访2～24个月,平均11个月,再植指有4指指甲增厚畸形,3指指腹有不同程度萎缩,24指指腹外观饱满,有23指感觉及运动恢复正常,两点辨别觉为4～6 mm,4指感觉恢复稍差,运动正常. 结论 指动脉静脉化在末节断指再植中是解决静脉回流的一种有效方法.     

小腿外侧皮瓣修复手部皮肤缺损的临床应用

目的 探讨小腿外侧皮瓣修复手部皮肤缺损的临床应用.方法 对15例手部皮肤缺损面积大小约2.5 cm×3.2 cm～3.8 cm×5.0 cm的患者,采用小腿外侧皮瓣游离移植修复.皮瓣穿支动脉与手部动脉、伴行静脉或皮下静脉与手背静脉吻合,小腿供区创面直接缝合.结果 15例皮瓣全部存活,1例皮瓣术后出现血管危象,行手术探查重新吻合血管后存活,4例皮瓣术后3个月行皮瓣整形术.术后随访时间为2个月至2年,平均11个月,手部皮瓣外观满意,功能恢复良好;小腿供区隐蔽,创面仅留线状瘢痕.结论 小腿外侧皮瓣修复手部皮肤缺损是一种较理想的方法.     

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.