手部创伤性骨关节缺损的处理  

Treatment of traumatic defects of bone and joints in the hand

作　　者：褚晓朝[1] 陶惠人[1] 朱庆生[1] 傅炳峨[1] 

机构地区：[1]第四军医大学西京医院全军骨科研究所

出　　处：《中华手外科杂志》1995年第3期176-179,共4页Chinese Journal of Hand Surgery

摘　　要：治疗手部骨关节缺损常采用植骨内固定、关节融合、关节成形及关节置换等方法．为总结经验，对１９８９年以来１０１例手部创伤性骨与关节缺损进行分析。单纯掌、指骨缺损３９例，行直接短缩对位，克氏针内固定６例，１例发主骨不连；对３３例缺损较大者用自体骨块植入克氏针交叉内固定，部分病例同时植人ＲＢＸ或异体骨粒，１０例发生延迟愈合，余全部正常愈合。骨与关节部分或完全缺损６２例，采用关节成形术４６例，其中以肋软骨移植效果最好，骨膜移植次之，筋膜衬垫或硅胶膜植入法较差；行关节融合术１１例．均达顺利融合；采用自体关节置换５例，均成活，术后关节活动度均＞７０°。我们认为：自体骨块植入克氏针交叉内固定，必要时植入ＲＢＸ骨粒．是治疗手部创伤性骨缺损的有效方法。关节缺损应按关节的重要性，分别采用关节融合术、关节成形术或关节置换术。The basic methods to treat the defects of bone and joints include bone grafting, internal fixation,arthodesis, arthoplasty and joint replacemen 39 cases of simple metacarpal or Phalangeal defects underwent direct shorten- ing, 6 cases underwent internal fixation with Kirshner wire and non-union occurred in one case;of the33 cases of more extensive defects underwent bone grafting and internal fixation with cross Kitshner wires, and reconstitute bone xenograft (RBX) used simultaneously in some cases, all healed normally with except 10 cases of delayed heal. In the 62 cases of bone and joints defects, 46 patients underwent arthroplasty, and best result was obtained in costicartilage grafting, followed by periosteum grafting,plantation of fascia or silica gel membrane had pooreffect. 11 patients underwent arthrodesis and the results were satisfactory. 5 patienls underwent free joint transplantation and all succeeded , the range ofmotion of the joints reached 70 degrees. We Consider the method of bone autografting with cross Kishner wire fixation, and with RBX implantation if necessary, is effective for traumatic bone defects in thehand. According to different joint defects, arthrodesis, arthroplasty or joint replacement were adopted.

关 键 词：手损伤 骨移植 骨关节缺损 

分 类 号：R658.205[医药卫生—外科学] R684.705[医药卫生—临床医学]