断腕再植术后手内在肌挛缩  

Intrinsic muscle contracture of the hand following wrist replantation

作　　者：师继红[1] 黄耀添[2] 傅炳峨[2] 朱庆生[2] 

机构地区：[1]成都军区昆明总医院全军骨科中心,昆明650032 [2]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》1997年第4期207-209,共3页Chinese Journal of Hand Surgery

摘　　要：探讨断腕再植术后手内在肌挛缩的发生率、治疗方法及预防。方法:作者总结了近24年内进行断腕再植并得到随访的63例资料,对其中发生手内在肌挛缩41例的发病机理、治疗结果及预防进行了分析和讨论。结果:63例断腕再植术后有41例发生手内在肌挛缩,发生率为65％。缺血时间超过16小时与16小时内的断腕再植术后手内在肌挛缩的发生率,两者差异有显著性意义(t=3.81,p<0.05)。二期行手内在肌手术矫正者效果不理想。结论:断腕再植术后手内在肌挛缩的处理关键在于预防。清创后用肝素化全血对离断手进行灌注,早期行手内在肌筋膜间区减压,将会取得较好的效果。Objective:To consider the morbility of hand intrinsic muscle contracture after wrist replantation, and the methods of treatment and prevention. Methods: 63 cases of wrist replantation performed in the past 24 years were reviewed. The pathogenic mechanism, operative results and prevention methods were studied in 41 cases with intrinsic muscle contracture. Results: 41 of 63 cases of wrist replantation presented intrinsic muscle contracture,the morbility being 65%. The incidence of intrinsic muscle contracture of the cases with ischemia over 16 hours was remarkably higher than that of the cases with ischemia within 16 hours (t=3. 81, P<0. 05). Corrective surgical procedures were frequently ineffective. Conclusion: Prevention is the most important management to the intrinsic muscle contracture following wrist replantation. Perfusion of the severed hand with heparinized blood after debridation and early decompression of intrinsic muscular fascia usually lead to good results.

关 键 词：再植术 肌 骨骼 挛缩 综合预防 

分 类 号：R658.1[医药卫生—外科学]