V-Z皮瓣成形术矫正上肢关节瘢痕挛缩畸形  

Correction of scar contracture deformity of upper limb joints with V-Z flap plasty

作　　者：刘宗超[1] 马川[1] 杨家福[1] 华强[1] 王振龙[1] 付麟伟[1] 江峰[1] 

机构地区：[1]泸州医学院附属中医院骨创伤科,四川泸州646000

出　　处：《泸州医学院学报》2012年第6期612-614,共3页Journal of Luzhou Medical College

摘　　要：目的：探讨V-Z皮瓣成形术矫正上肢关节瘢痕挛缩畸形的临床疗效。方法：2005年1月至2009年5月我院共收治上肢关节部位瘢痕挛缩畸形53例,其中男29例,女24例,年龄1.5~30岁,平均年龄（18.7±3.5）岁;病程最短5个月,最长4年,平均1.5年;其中肩关节20例,肘关节18例,腕关节15例;致伤原因：烫伤20例,烧伤10例,车祸伤18例,绞伤5例;其中初次手术者38例,再次手术者15例;瘢痕面积：3cm×1cm～30cm×6cm,所有关节畸形均无骨性畸形,均进行了矫形手术,术中软组织瘢痕松解均采取V-Z联合皮瓣成形术。结果：术后所有病例随访6～12月（平均10.6±2.7月）,53例患者的所有皮瓣及供区植皮均存活,其中有4例患者表皮坏死,经换药后2周愈合。术后肩关节Constant评分：优11例,良8例,差1例,优良率95%;肘关节Mayo评分：优11例,良7例,差0例,优良率100%;腕关节Krimmer评分：优9例,良5例,差1例,优良率93%;所有患者均进行DASH[1]评分,术后明显低于术前,差别有统计学意义（P〈0.05）。结论：V-Z联合皮瓣成形术,能够很好的矫正上肢关节瘢痕挛缩畸形,该方法切取简单,创伤小,减小植皮面积或避免植皮,术后瘢痕形成面积小,关节功能恢复好。Objective：To evaluate the clinical efficacy of V-Z flap plasty in correction of scar contracture deformity of upper limb joints.Methods：From January 2005 to May 2010,53 cases of scar contracture deformity of upper limb joints,including 29 males and 24 females with an average age of 18.7±3.5 years（1.5-30years） including shoulder joint 20 cases,elbow joint 18 cases and wrist joint 15 cases.The average course of disease was 1.5 years（5 months to 4 years）,20 cases were damaged by empyrosis,10 cases by burn,18 cases by road accident and 5 cases by twist.The area of cicatricle was from 3cm×1cm to 30cm×6cm.38 cases were treated by primary operation and 15 cases by one more.All the cases without bone deformation were treated with V-Z flap plasty.Results： All the patients were followed-up,for 10.6±2.7 months（6~12 months）.The range of montion of shoulder,elbow and wrist joint had varied improvement in 53 cases.All the skin flaps and skingrafting of donor site survived,the cuticle necroses were observed on the flaps of 4 cases,but cured after 2 weeks of dressing change.According to shoulder joint Constant scores after operation ： the results were excellent in 11 cases,good in 8 cases,and poor in 1 case,the good rate was 95%.According to elbow joint Mayo scores after operation： the results were excellent in 11 cases,good in 7 cases,and poor in 0 case,the good rate was 100%;According to wrist joint Krimmer scores after operation： the results were excellent in 9 cases,good in 5 cases,and poor in 1 case,the good rate was 93%.There was significant difference（P〈0.01） before and after operation in all patients according to DASH scores.Conclusion： With easy operation,less injury,reducing or avoiding an area of skin graft,less area of scar formation,best recovery of joint function,and the technique of V-Z flap plasty could correct the scar contracture deformity of upper limb joint.

关 键 词：V-Z联合皮瓣 上肢关节 瘢痕挛缩 关节活动范围 

分 类 号：R684.2[医药卫生—骨科学]