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.

The cause and management of ulnar club-hand secondary to crush injury in the palm

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.