支具加显微外科手术治疗重度虎口瘢痕挛缩的临床研究

目的 总结支具加显微外科手术在重度虎口瘢痕挛缩治疗的作用，探讨重度虎口瘢痕挛缩综合治疗的重要性。方法 自2000年4月-2004年10月。对76例重度虎口挛缩患者术前采用支具被动牵引治疗后，根据虎口挛缩情况进行植皮、“Z”字成形术度各种带蒂或游离皮瓣修复，拆线后，再以支具固定，以物理测量评价疗效。对所有数据进行统计学分析。结果 76例患者，术前进行15-90d治疗，虎口角、虎口宽度、手功能均明显增大。2例取消手术治疗，16例简化手术方案，35例缩小取皮范围。结合手术治疗74例，6个月后随访，虎口扩大优69例，良7例；手功能优16例，良33例，中25例，差2例。结论 支具加显微外科手术可有效扩大虎口、简化手术难度，缩小取皮范围，预防术后虎口再度挛缩的几率，是一种简便、有效的治疗方法。

Clinical research on treatment of severe fiest-web space cicatrical contracture by orthosis plus micro-surgery

[Objective] To sum up the therapeutic effect of severe first-web space cicatricial contracture by orthosis plus microsurgery and investigate the comprehensive therapeutic significance of severe first-web space cicatricial contracture. [Method] From April, 2000 to October, 2004, 76 cases with severe first-web space cicatricial contracture, after being treated by orthosis passive traction before operation, underwent skin graft, "Zigzag" type plastic operation, and repairment of various pedicles and free skin; after stitich removing, were fixed by orthosis, their efficacy was evaluated by physical measurements and all the data were analyzed by statistics. [Results] 76 cases were treated for 15 to 90 days before operation, their first-web space angles, first-web space width, hand function increased significantly. 2 cases concelled surgical treatment. 16 cases simplified their surgical schemes. 35 cases narrowed down the scope of removing skin. Among 76 cases combined by surgical treatment, by six months of follow-ups, 69 cases were excellent in enlargement of the first-web space, 7 appeared better, 16 cases were excellent in hand functions, 33 cases better, 25 improved, and 2 poor. [Conclusion] Orthosis plus microsurgery can effectively expand the first-web space, simplify the operation difficulty, narrow down the scope of skin removing and prevent the first-web space from repeated contracture after operation, so it is an easy, effective therapeatic method.