Search

微型外固定支架在虎口外伤急诊治疗中的应用及疗效

目的探讨微型外固定支架在急诊治疗虎口外伤中的应用及临床疗效。 方法2009年2月－2011年6月，收治虎口外伤患者34例。男21例，女13例；年龄18～65岁，平均31.4岁。致伤原因：机器冲压伤15例，重物压砸伤12例，切割伤5例，爆炸伤2例。受伤至入院时间20 min～6 h 30 min。按创伤程度及范围，26例为简单损伤，8例为复合性损伤。急诊清创后一期微型外固定支架开大虎口或联合虎口“Z”字成形治疗，复合性损伤者二期行皮瓣修复。 结果术后1例发生针道感染，经对症处理后愈合；其余患者切口均Ⅰ期愈合，复合性损伤患者皮瓣及供区植皮均顺利成活。31例获随访，随访时间5～14个月，平均7.5个月。末次随访时虎口开大角度为65～95°，平均80°。拇指指间关节纹尺侧点与示指掌指关节桡侧点距离为4.0～5.5 cm，平均4.8 cm；按顾玉东等的评价方法评价，获优19例，良10例，差2例，优良率达93.5%。 结论在虎口外伤急诊治疗中，采用微型外固定支架开大虎口，手术操作简便，损伤小，避免了虎口挛缩的发生。

UPPER LIMB FREE FLAP FOR REPAIR OF SEVERE CONTRACTURE OF THUMB WEB AND ONE STAGE RECONSTRUCTION OF INDEX FINGER ABDUCTION

ObjectiveTo evaluate the effectiveness of the upper limb free flap for repair of severe contracture of thumb web, and one stage reconstruction of the index finger abduction. MethodsBetween March 2007 and June 2011, 16 cases of severe contracture of thumb web and index finger abduction dysfunction were treated. There were 14 males and 2 females with an average age of 29 years (range, 16-42 years). All injuries were caused by machine crush. The time between injury and admission was 6-24 months (mean, 10 months). The angle of thumb web was 10-25° (mean, 20°), and the width of thumb web was 15-24 mm (mean, 22 mm). After scar relax of the thumb web, the defect size ranged from 6 cm × 4 cm to 8 cm × 6 cm; the upper limb free flap from 7 cm × 5 cm to 9 cm × 7 cm was used to repair the defect, index finger abduction was simultaneously reconstructed by extensor indicis proprius tendon transfer. The donor site was repaired with skin grafting. ResultsAll the flaps and skin graftings survived after operation and incisions healed by first intention. Fourteen patients were followed up 6-12 months (mean, 9 months). The flap appearance was satisfactory. The two-point discrimination was 6-9 mm (mean, 7 mm) after 6 months. The angle of thumb web was 85-90° (mean, 88°). The width of thumb web was 34-52 mm (mean, 40 mm). The abduction and opposing functions of thumb and abduction function of index finger were both recovered. Conclusion A combination of the upper limb free flap for severe contracture of thumb web and one stage reconstruction of the index finger abduction for index finger abduction dysfunction can achieve good results in function and appearance.

第一掌骨一期延长联合虎口加深成形术治疗拇指缺损远期疗效

目的 总结第1掌骨一期延长联合虎口加深成形术治疗拇指Ⅱ～Ⅲ度缺损的远期疗效。 方法回顾分析1985年8月－1988年8月收治并获24年以上随访的8例拇指Ⅱ～Ⅲ度缺损患者临床资料。男5例，女3例；年龄20～53岁，平均38岁。拇指残端创面愈合至拇指再造时间为4个月～2年，平均9个月。采用第1掌骨截骨后一期延长1.8～2.0 cm再造拇指，同时作虎口“Z”字成形加深术。 结果术后切口均Ⅰ期愈合。随访时间24～26年。再造拇指感觉无异常改变，均能完成对指和握持，不能完成对掌。虎口无继发挛缩，拇指内收、外展活动度30～90°，肌力5～6 级。根据中华医学会手外科学会上肢部分功能评定试用标准评定，均获优良。 结论第1掌骨一期延长联合虎口加深成形术治疗拇指Ⅱ～Ⅲ度缺损，具有手术操作简便、成功率高、远期疗效好等优点。

RECONSTRUCTION OF SEVERE CONTRACTURE OF THE FIRST WEB SPACE AND WRIST BY INCORPORATING PEDICLED RETROGRADE FLAP OF FOREARM TRANSPLANTATION

Objective To summarize the therapeutic effectinevess of incorporating pedicled retrograde flap of forearm transplantation for reconstructing severe contracture of the first web space and wrist. Methods Between November 2005 and February 2010, 26 patients with severe contracture of the first web and wrist were treated. There were 18 males and 8 females with an average age of 27 years (range, 12-45 years). The locations were the right sides in 15 cases and the left sides in 11cases. The injury reason included hot water scald in 7 cases, explosion hurt in 5 cases, traffic accident in 3 cases, hot pressing in 5 cases, and flame burns in 6 cases. The duration of scar contracture ranged from 6 to 26 months with an average of 11 months. According to the evaluation standard by GU Yudong et al., all had severe contracture of the first web space, and concomitant injuries included adduction deformity thumb, l imitation of the thumb extension and opposition function, and carpometacarpal flexion joint deformity. After scar contracture was released, the defect size ranged from 5.8 cm × 4.5 cm to 11.3 cm × 7.2 cm, which were repaired by the incorporating pedicled retrograde flap of forearm of 6.5 cm × 5.0 cm to 12.5 cm × 8.0 cm at size. The donor sites were directly sutured or repaired with skin graft. Results Bl ister and partial necrosis occurred at the distal end of the flaps in 2 cases, which were cured after dressing change. The other flaps survived and wounds healed by first intention. Incisions at donor sites healed by first intention. Twenty-six patients were followed up 6 to 24 months (mean, 15 months). The patients had functional recovery in thumb adduction and opposition at different degrees. At 6 months after operation, according to the Swanson et al. AMA system for total thumb activity, the total thumb function was improved significantly, and according to Jensen et al. measurement, the width and angle of the first web space were significantly increased, all showing significant differences (P lt; 0.05). Conclusion Incorporating pedicled retrograde flap of forearm transplantation for repairing severe contracture of the first web space and wrist could augment the first web space and improve the wrist flexible function.

第二掌骨背侧岛状皮瓣修复拇指掌侧及虎口区皮肤软组织缺损

目的 总结采用第2 掌骨背侧岛状皮瓣修复拇指掌侧及虎口区皮肤软组织缺损的方法及疗效。 方法 2006 年5 月－ 2008 年5 月，采用第2 掌骨背侧岛状皮瓣修复拇指掌侧及虎口区皮肤软组织缺损19 例。男12 例，女7 例；年龄15 ～ 42 岁，平均27 岁。机器压砸伤18 例，虎口区组织挛缩1 例。压砸伤患者中，拇指末节缺损11 例，拇指近节缺损5 例；虎口区皮肤缺损2 例；皮肤软组织缺损范围为2.2 cm 1.0 cm ～ 3.8 cm 2.4 cm。压砸伤患者均为受伤后3 h 内手术，虎口区组织挛缩患者为伤后6 个月手术。术中皮瓣切取范围为2.8 cm 1.2 cm ～ 4.0 cm 2.6 cm，供区采用中厚皮片游离植皮修复。 结果 术后皮瓣及供区皮片均顺利成活，创面Ⅰ期愈合。术后患者均获随访，随访时间6 ～ 24 个月。拇指外形饱满，感觉恢复至S2+；屈伸、外展、对掌、对指功能良好。虎口张开度为80 ～ 85°。 结论 第2 掌骨背侧岛状皮瓣修复拇指掌侧及虎口区皮肤软组织缺损具有手术操作简便、皮瓣质量好、术后皮瓣成活率高等优点，可获得较好疗效。

CLINICAL APPLICATION OF GROIN SKIN AND ILIAC BONE COMPOSITE GRAFT IN CONTRACTURE OF FIRST WEB SPACE AND RECONSTRUCTION OF POLLICIS OPPONENS FUNCTION

Objective To investigate the therapeutic effects of the groin skin and iliac bone composite graft on the repair of severe contracture of the first web space and one-stage reconstruction of the pollicis opponens function under the condition of no ideal muscle or tendon used. Methods From July 2003 to February 2006, 5 patients (4 males, 1 females; age range, 2038 years) with severe contracture of the first web space with loss of the pollicis opponens function were treated by the groin skin and iliac bone composite graft, with the clinical observation performed. The defect was caused by a crush injury in 3 patients, by an explosion injury in 1 patient, and by awrist joint mutilation injury in 1 patient. They all had been treated by operation at least once with a disease course of 6-24 months. The width and the angle of the first web space was 18 mm and 20° on average. Results The followed-up for 612 moths revealed that all the flaps had a success. The pedicle of the groin skin and iliac bone composite graft was cut off after 3 weeks, and 8 weeks later there was a bone union between the imbedded bone block and the first and second metacarpal bones. There was no evidence that the imbedded bone block was deformed or absorbed. The width of the first web space was augmented by an average of 32 mm, the angle of the first web space was augmented by an average of 60°. The pollicis opponens function recovered. Conclusion It is relatively simple and reliable to repair the contracture of the first web space and reconstruct the pollicis opponens function in one-stage usingthe groin skin and iliac bone composite graft.

前臂桡侧逆行岛状皮瓣修复虎口皮肤及软组织缺损一例

One-stage thumb opponensplasty and polygonal flap in congenital spade hand reconstruction

ObjectiveTo explore the effectiveness of one-stage metacarpal osteotomy, thumb opponensplasty and polygonal flap reconstruction in the treatment of congenital spade hand deformity. MethodsEight cases of congenital spade hand were treated between January 2013 and March 2017. There were 5 males and 3 females, with an average age of 17.5 months (range, 13-35 months). The clinical manifestations of all the children were congenital spade hand and the affected hand was shorter than the healthy side. The contralateral hand was normal and there was no chest, skull, or facial deformity. The operation was performed with metacarpal osteotomy and thumb opponensplasty, and through the dorsal metacarpal rectangular flap to reconstruct the first web and through rotation of polygonal skin flap to reconstruct thumb web and lateral fold of thumb index nail. The dorsal ulnar and proximal radial segment of thumb were repaired by skin grafting. A vernier caliper was used to measure the first web space and the thumb function was evaluated by modified Tada score. ResultsThe reconstruction of palmar function and the formation of first web were completed in one stage in 8 children. Skin grafting on the dorsal ulnar side of thumb and radial side of index finger survived after operation. All the children were followed up 13-29 months, with an average of 16.1 months. There was no infection, skin flap necrosis, lateral deviation of thumb, scar contracture, or other complications. At last follow-up, there was no significant difference in skin color between the healthy side and the first web of the affected hand. The opening distance of first web space was 3.5-5.0 cm, with an average of 4.2 cm. According to the modified Tada scoring system, the results were excellent in 7 cases and good in 1 case, with an excellent and good rate of 100%. The thumb could grasp and pinch actively, and the palm opposition function was good. ConclusionOne-stage thumb opponensplasty combined with polygonal flap for reconstruction of congenital spade hand deformity can improve hand function very well. The reasonable designing of skin flap can effectively cover important areas, and the operation is safe and reliable.

M 形皮瓣在儿童 Wassel Ⅳ型复拇指畸形合并虎口狭窄矫形术中的应用

目的总结儿童 Wassel Ⅳ型复拇指畸形合并虎口狭窄矫形术中应用 M 形皮瓣修复创面的疗效。方法2010 年 5 月—2018 年 12 月，收治 10 例Wassel Ⅳ型复拇指畸形合并虎口狭窄患儿。男 7 例，女 3 例；年龄 1～5 岁，平均 1.9 岁。轻度虎口挛缩 5 例，中度 5 例。术中切除桡侧指体并开大虎口后，应用 M 形皮瓣修复创面。结果术后皮瓣均成活，创面Ⅰ期愈合。患儿均获随访，随访时间 8～15 个月，平均 12 个月。患儿家属对拇指外形满意，拇指对掌及对指功能良好，虎口未进一步挛缩。末次随访时，根据改良 Tada 评分标准，获优 9 例、良 1 例，优良率 100%。结论儿童 Wassel Ⅳ型复拇指畸形合并虎口狭窄矫形术中，采用 M 形皮瓣修复重建虎口，操作简便，不增加额外损伤，疗效满意。