掌腱膜挛缩症中手指屈曲畸形治疗的临床研究  

Clinical study of the correction of finger flexion deformity in Dupuytren＇s disease

作　　者：沈尊理[1] 黄一雄[1] 郭效朋[1] 邢书亮[1] 张兆峰[1] 沈华[1] 贾万新[1] 

机构地区：[1]上海交通大学附属第一人民医院整形外科,上海200080

出　　处：《中国美容整形外科杂志》2010年第12期725-727,共3页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的 研究掌腱膜挛缩症中手指屈曲畸形矫治方法 及其疗效.方法 本组患者17例,其中男性15例,女性2例;平均年龄58岁.均有掌腱膜挛缩症,伴小指屈曲挛缩8侧,伴环小指屈曲挛缩8侧,伴中环指屈曲挛缩1侧,伴环指屈曲挛缩2侧,共19侧.沿掌腱膜挛缩索带纵轴设计锯齿状切口,彻底切除病变的挛缩腱膜组织及其附近5 mm范围的腱膜组织.然后稍加外力松解指关节周围的挛缩组织,使手指恢复伸直位.术后2周给予手指伸直位石膏托制动.结果 所有患者随访6～24个月.锯齿形皮瓣均存活,未见神经肌腱损伤并发症.手掌部皮瓣尖角出现血运障碍2例,经换药后完全愈合.未见手指屈曲挛缩复发,手指屈伸活动度恢复优良率100%.结论 采用锯齿状切口,应注意保护皮瓣血运和指神经血管束,彻底切除松解病变的腱膜组织,可有效矫正掌腱膜挛缩引起的手指屈曲畸形,避免并发症的发生.Objective To explore the surgical technique and its result in correcting the finger contracture in Dupuytren＇s disease. Methods Seventeen cases of Dupuytren＇s disease with 58 years mean age were studied in this group （ 15 males and 2 females）. Among them, 8 sides were with flexion eontraeture of little finger, 8 sides with flexion eontracture of little and ring fingers, 1 side with flexion contracture of middle and ring fingers, 2 cases with flexion contracture of middle finger. They were corrected by excising the contracted aponeurosis and the tissue around it in 5 mm though the zigzag incision designed along the longitudinal axis of the pahnar aponeurosis contracture cord, then loosening the contracted tissue around finger joint with slight finger joint to make the fingers in straight position. Plaster slab braking was performed at the 2 weeks postoperatively. Results After 6 - 24 months follow-up. All zigzag flaps survived without nerves and tendon injuries except for 2 cases with circulation crisis at the flap tip which was healed with dressing change. There was no recurrence of finger flexion contracture. The recovery rate of flexion and extension of finger was 100%. Conclusion The finger contractures caused by Dupuytren＇s disease could be corrected effectively by completely removing and releasing of the diseased fascia through the multiple zigzag incisions. Care should be taken to protect the blood supply of the flaps and digital nerves as well as arteries to avoid complications.

关 键 词：掌腱膜挛缩症 手指 屈曲畸形 皮瓣 

分 类 号：R622[医药卫生—整形外科]