显微外科治疗掌腱膜挛缩症28例疗效分析  

Analysis of microsurgical treatment of 28 cases of Dupuytren's contracture

作　　者：钱晓忠[1] 丁任[1] 包朝鲁[1] 马台[1] 黄健华[1] 徐进[1] 龚韶华[1] 孙建忠[1] 支晓丞[1] 

机构地区：[1]上海中医药大学附属曙光医院宝山分院手外科,上海201900

出　　处：《西部医学》2014年第2期224-226,共3页Medical Journal of West China

摘　　要：目的 观察掌腱膜挛缩症不同手术方法的疗效.方法 观察显微镜下掌腱膜完全切除术组8例12只手（侯明钟分级法：Ⅰ级1只手,Ⅱ级2只手,Ⅲ级4只手,Ⅳ级5只手）和掌腱膜部分切除术组20例29只手（侯明钟分级法：Ⅰ级2只手,Ⅱ级9只手,Ⅲ级10只手,Ⅳ级8只手）的并发症及手术疗效,并随访功能恢复情况.所有病例均取术中切除的掌腱膜行病理检查.结果 两组病例术中均矫正畸形.掌腱膜部分切除术组有1只手出现指神经、血管损伤,其余40只手均未出现并发症.术后随访1～8年,采用Adam评定法,显微镜下掌腱膜完全切除术组功能恢复优良率100％;掌腱膜部分切除术组14只手功能恢复优良,15只手功能恢复不满意,优良率48.28％.掌腱膜完全切除术组功能恢复优良率显著高于掌腱膜部分切除术组（P＜0.01）.所有病例病理学检查结果均为纤维瘤.结论 掌腱膜挛缩症应早期发现,早期诊断,早期行显微镜下掌腱膜完全切除术,同时切除受累皮肤,不易损伤指神经、血管,长期随访疗效明确,功能恢复优良.Objective To analyze and compare the therapeutic effects of two surgical methods m managemcm uL Dupuytren＇s contracture. Methods The clinical data of 28 cases of Dupuytreffs contracture were retrospectively analyzed. Eight cases （12 hands） in palm aponeurosis excision group underwent palm aponeurosis excision under microscope （HOU Ming-zhong grading：l hand in level ]_ , 2 hands in level lI , 4 hands in level Ill , and 5 hands in level for）, and 20 cases （29 hands） underwent palm aponeurosis partial excision in palm aponeurosis partial excision group （HOU Ming-zhong grading： 2 hands in level 1~ , 9 hands in level 11 , 10 hands in level UI, and 8 hands in level lg）. The incidences of com- plications and therapeutic effects were observed, and the function recovery was followed up in two groups. The samples of excised palm aponeurosis of all cases were taken for pathological examinations. Results All the deformities were cor- rected after operation in two groups. Neurovaseular injury occurred in 1 hand in palm aponeurosis partial excision group, and there was no complication in the other 40 hands. Patients were followed up for 1 to 8 years with Adam Assessment. The function recovery of all the 12 hands in palm aponeurosis excision group was excellent or good, and the excellent and good rate was 100~. In palm aponeurosis partial excision group, the [unction recovery o{ 14 hands was excellent or good, and the excellent and good rate was 48.28~~. The excellent and good rate in palm aponeurosis excision group was significantly higher than that in palm aponeurosis partial excision group （P〈0.01）. All the samples of excised palm apo- neurosis were confirmed as fibroma by pathological examinations. Conclusion Dupuytren＇s contracture should be early detected and diagnosed, and palm aponeurosis excision under microscope should be timely carried out with the excision of affected skin, which can avoid neurovaseular injury and obtain favorable function recovery.

关 键 词：手 掌腱膜挛缩 显微外科 

分 类 号：R682.15[医药卫生—骨科学]