外伤性掌指关节僵硬的手术治疗

目的探讨手部机器压伤后第2～5指掌指关节僵硬的手术方法及疗效。方法 2006年1月-2009年6月,收治7例第2～5指掌指关节僵硬患者。男6例,女1例;年龄18～56岁,平均32岁。优势手5例,非优势手2例。7例均为机器压伤,6例为伴多发掌骨骨折或脱位术后;1例为手掌中远段平面完全离断再植术后。手术切口愈合后至该次入院时间为3～15个月。患手夹纸试验均呈阳性;X线片示骨折均愈合。先物理治疗软化手部瘢痕1个月,再采用一期掌指关节松解术及蚓状肌功能重建术治疗,外固定6周后行物理治疗和功能锻炼。结果术后切口均Ⅰ期愈合。患手掌指关节屈伸活动稳定,无伸肌腱侧方滑脱,手指抓、握功能接近正常。术后6例获随访,随访时间6个月～3年。手指掌指关节伸直0°,主动屈曲67～90°。优势手握力达健侧的86.70%,非优势手达健侧的66.70%;优势手拇指捏力达健侧的83.52%,非优势手达健侧的61.30%。按照中华医学会手外科学分会全指关节活动度(TAM)系统评定:获优4例,良1例,可1例,优良率为83.33%。结论对于外伤性掌指关节僵硬患者,给予瘢痕软化后一期行掌指关节松解术及蚓状肌功能重建术,可恢复掌指关节功能,获得较好疗效。

Surgical treatment of stiff metacarpophalangeal joint after hand injury

Objective To discuss the surgical procedures and curative effect of stiff 2-5 metacarpophalangeal(MP) joints after crash injury in hand.Methods Between January 2006 and June 2009,7 cases of stiff 2-5 MP joints were treated by releasing the stiff MP joints and reconstructing the function of lumbrical muscle in one stage.There were 6 males and 1 female with an average age of 32 years(range,18-56 years).All injuries were caused by crash.Six cases suffered from multiple metacarpal fracture or complex dislocatio...