应用Ilizarov技术治疗手腕部瘢痕挛缩畸形临床观察

目的 观察Ilizarov技术治疗手腕部瘢痕挛缩畸形的临床效果。 方法 2017年4月~2020年1月，应用Ilizarov技术治疗7例手腕部瘢痕挛缩畸形患者，男3例，女4例；年龄12~52岁，平均24岁；左手部2例，左腕关节1例，右腕关节4例；创面感染致瘢痕增生2例，开水烫伤致瘢痕增生1例，火焰烧伤致瘢痕增生4例。瘢痕形成6月~34年，平均7年。根据Mayo评分法评估手腕部功能，术前患者手腕部功能可5例，差2例。 结果 腕关节畸形均获得矫正，以腕关节中立位为0°测量，腕关节掌屈可达到55~70°，背伸可达0~55°，无明显疼痛及麻木感，手指活动灵活。患者均无针道感染、肢端感觉麻木等并发症。术后随访5月~24月（平均15月），末次随访时评估手腕部功能，良4例、可3例，较术前显著改善。 结论 应用Ilizarov技术治疗手腕部瘢痕挛缩畸形安全有效，可为烧伤后肢体功能重建提供一种新的疗法。

Clinical observation of the treatment of wrist scar contracture deformity by Ilizarov technique

Objective To explore the therapeutic effect of Ilizarov technique on wrist scar contracture deformity. Methods Seven patients with wrist scar contracture deformity were treated with Ilizarov technique from April 2017 to January 2020(3 males and 4 females). The age ranged from 12 to 52, with an average of 24 years old. There were 2 cases of left hand, 1 case of left wrist, 4 cases of right wrist. Scar hyperplasia occurred in 2 cases due to wound infection, 1 case due to boiling water scald and 4 cases due to flame burn. Scar formation last from 6 months to 34 years, with an average of 7 years. The wrist function was evaluated according to Mayo score, the function was good in 5 cases and poor in 2 cases before operation. Results The deformity of wrist was corrected. The measurement of neutral position of the wrist was 0°. The carpal flexion could reach 55~70°, and the dorsi extension could reach 0~55°. The postoperative follow-up was conducted for 5 to 24 months, with an average of 15 months. There were no complications such as needle tract infection and extremity numbness . At the last follow-up, wrist function was evaluated according to Mayo score. The function was good in 4 cases, fair in 3 cases, which were significantly improved compared with preoperative results. Conclusions Ilizarov technique is safe and effective in the treatment of wrist scar contracture deformity, which provides a new method for limb function reconstruction after burns.