外伤性掌指关节僵硬的手术治疗  

SURGICAL TREATMENT OF STIFF METACARPOPHALANGEAL JOINT AFTER HAND INJURY

作　　者：芮永军[1] 施海峰[1] 糜菁熠 陈光[1] 王骏[1] 钱俊[1] 

机构地区：[1]无锡市手外科医院,江苏无锡214061

出　　处：《中国修复重建外科杂志》2011年第5期538-541,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨手部机器压伤后第2～5指掌指关节僵硬的手术方法及疗效。方法 2006年1月-2009年6月,收治7例第2～5指掌指关节僵硬患者。男6例,女1例;年龄18～56岁,平均32岁。优势手5例,非优势手2例。7例均为机器压伤,6例为伴多发掌骨骨折或脱位术后;1例为手掌中远段平面完全离断再植术后。手术切口愈合后至该次入院时间为3～15个月。患手夹纸试验均呈阳性;X线片示骨折均愈合。先物理治疗软化手部瘢痕1个月,再采用一期掌指关节松解术及蚓状肌功能重建术治疗,外固定6周后行物理治疗和功能锻炼。结果术后切口均Ⅰ期愈合。患手掌指关节屈伸活动稳定,无伸肌腱侧方滑脱,手指抓、握功能接近正常。术后6例获随访,随访时间6个月～3年。手指掌指关节伸直0°,主动屈曲67～90°。优势手握力达健侧的86.70%,非优势手达健侧的66.70%;优势手拇指捏力达健侧的83.52%,非优势手达健侧的61.30%。按照中华医学会手外科学分会全指关节活动度(TAM)系统评定:获优4例,良1例,可1例,优良率为83.33%。结论对于外伤性掌指关节僵硬患者,给予瘢痕软化后一期行掌指关节松解术及蚓状肌功能重建术,可恢复掌指关节功能,获得较好疗效。Objective To discuss the surgical procedures and curative effect of stiff 2-5 metacarpophalangeal（MP） joints after crash injury in hand.Methods Between January 2006 and June 2009,7 cases of stiff 2-5 MP joints were treated by releasing the stiff MP joints and reconstructing the function of lumbrical muscle in one stage.There were 6 males and 1 female with an average age of 32 years（range,18-56 years）.All injuries were caused by crash.Six cases suffered from multiple metacarpal fracture or complex dislocation of MP joint and 1 case suffered from complete amputation at level of middle palm of hand.The interval from initial wound healing to hospitalization was 3 to 15 months.Before operation,the X-ray fi lms showed fracture healed and the results of nipping paper test were positive.All hands were treated with physical therapy for 1 month.After the plaster external fixation for 6 weeks,the physical therapy and function training were given.Results All wounds healed by first intention.The patients had no joint instability and extensor tendon side-slipping with normal finger function.Six patients were followed up from 6 months to 3 years.The extension and flexion of MP joint were 0° and 67-90°,respectively.The average grip strength of injured dominant hand reached 86.70% of normal side and non-dominant hand reached 66.70% of normal side.The average injured dominant tip pinch strength reached 83.52% of normal side and non-dominant tip pinch strength reached 61.30% of normal side.Based on total active motion（TAM） system of Chinese Medical Association for Hand Surgery,the results were excellent in 4 cases,good in 1 case,and fair in 1 case;the excellent and good rate was 83.33%.Conclusion In patients with stiff MP joint and lumbrical muscle defect,releasing stiff MP joint and reconstructing lumbrical function in one stage can recover the function of MP joint and achieve good outcome.Physical therapy plays an important role before operation.

关 键 词：掌指关节僵硬 掌指关节松解术 蚓状肌功能重建 

分 类 号：R687.3[医药卫生—骨科学]