尺侧腕伸肌联合拇短伸肌腱转移重建拇指对掌功能  

RECONSTRUCTION OF THUMB OPPOSITION FUNCTION BY TRANSFERRING EXTENSOR CARPI ULNARIS AND EXTENSOR POLLICIS BREVIS MUSCLE TENDONS

作　　者：崔岩[1] 李均[1] 陈波[1] 童哲[1] 

机构地区：[1]武警浙江省总队医院骨三科浙江嘉兴,314000

出　　处：《中国修复重建外科杂志》2011年第2期209-211,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的评价尺侧腕伸肌联合拇短伸肌腱转移重建拇指对掌功能的临床疗效。方法 2006年3月-2009年8月,采用尺侧腕伸肌联合拇短伸肌腱转移重建20例单纯腕部正中神经损伤、15例正中神经合并尺神经损伤患者的拇指对掌功能。其中男25例,女10例;年龄20～53岁,平均33.5岁。致伤原因:锐器伤24例,钝器伤9例,热压伤2例。合并尺、桡骨远端骨折6例。患者均于伤后1～3 h行神经修复术,平均2 h。受伤至该次入院时间为6～14个月,平均7.5个月。35例患者除2例单纯正中神经损伤拇外展功能不完全消失、无对掌功能外,其余拇外展及主动对掌功能完全消失。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间12～18个月,平均14个月。腕关节屈伸、拇指末节背伸活动正常。20例单纯正中神经损伤患者均恢复正常拇外展及对掌功能。15例合并尺神经损伤患者中,13例恢复正常对掌功能,2例对掌功能不全;拇外展功能均恢复良好。术后12个月,根据赵书强等拇指对掌功能评定标准,患者拇对掌功能测量值均在正常范围。结论对单纯正中神经损伤或合并尺神经损伤患者,尺侧腕伸肌联合拇短伸肌腱转移是一种操作简便且有效的手术方法。Objective To evaluate the results of thumb opposition function by transferring the extensor carpi ulnaris and the extensor pollicis brevis muscle tendons.Methods Between March 2006 and August 2009,35 patients with dysfunction of thumb opposition were treated and the thumb opposition function was reconstruced by transferring the extensor carpi ulnaris and the extensor pollicis brevis muscle tendons.There were 25 males and 10 females with an average age of 33.5 years（range,20-53 years）;20 had median nerve injury in the wrist and 15 had median nerve injury with ulnar nerve injury.The causes were sharp instrument injury in 24 cases,blunt injury in 9 cases,and hot crush injury in 2 cases.Six cases complicated by shaft fractures of radius and ulna.All the patients underwent an operation of nerve repair at 1 to 3 hours after injury（mean,2 hours）.The time from injury to reconstructing operation was 6-14 months（mean,7.5 months）.Two cases was able to abduct thumb slightly,the others had no functions of thumb abduct and thumb opposition.Results All the wounds gained the primary healing.The patients were followed up 12-18 months（mean,14 months）.The wrist joint angle and thumb dorsal extension were satisfactory.Thumb abduct and thumb opposition function returned to normal in 20 patients with simple median nerve injury;in 15 patients with median nerve injury and ulnar nerve injury,thumb abduct and thumb opposition function returned to normal in 15 and 13,respectively.According to ZHAO Shuqiang s standard,the results of thumb opposition function were normal in all patients at 12 months after operation.Conclusion It is a convenient and efficient procedure to reconstruct thumb opposition function by transferring the extensor carpi ulnaris and the extensor pollicis brevis muscle tendons.

关 键 词：正中神经损伤 尺侧腕伸肌 拇短伸肌腱 肌腱转移术 拇指对掌功能重建 

分 类 号：R687.2[医药卫生—骨科学]