断肢断腕断掌再植后手内在肌挛缩51例分析

探讨断肢断腕断掌再植术后手内在肌挛缩的发病机理,结合临床经验提出分类、预防和治疗方法。方法:对51例断肢(腕、掌)再植,分别采用术中切开骨间肌肌筋膜、掌腱膜及腕横韧带;术后严重肿胀时早期切开骨筋膜室;缺血时间超过10小时者,除上述措施外尚须切断或部分切除拇收肌和骨间肌肌腹。结果:采用上述预防措施后,手内在肌挛缩的发生率明显降低。结论:本症重在预防,如能及时、果断地采取措施,效果良好。一旦发生中、重度手内在肌挛缩应尽早手术。

Intrinsic muscle contracture of the hand following replantation of arm wrist and palm: a neport of 51 cases

Objectives To investigate the pathogenic mechanism of intrinsic muscle contracture after replantation.and put forward the classification,prevention and management of this clinical entity. Methods; 51 cases of arm(wrist, palm) replantation were involved. Such measures as discission of interosseous muscular fascia ,palmar aponeurosis and transverse carpal ligament were taken during replantation. When severe swelling was observed in the early postoperative period, the osteofascial compartment was opened. Resection or partial excision of interosseous muscles and adductor pollicis was carried out in patients with an ischemic period longer than 10 hours. Results:The morbility of contrac-ture of hand intrinsic muscles remarkable decreased after the preventive measures were taken. Conclusions: Prevention of this disorder is emphasized. Prompt and effective decompressive measures lead to satisfactory results. Once moderate or severe contracture occurs,corrective operation should be performed as soon as possible.