Ilizarov技术在拇指脱套伤截指术后功能重建中的应用  

Application of Ilizarov technique in functional reconstruction of thumb degloving injury after amputation

作　　者：王斌[1] 王辉[1] 孟钊[2] 刘伟[1] 郝睿峥[1] 张荐[1] 霍永新[1] 陈超[1] 贾松[1] WANG Bin;WANG Hui;MENG Zhao;LIU Wei;HAO Ruizheng;ZHANG Jian;HUO Yongxin;CHEN Chao;JIA Song

机构地区：[1]唐山市第二医院(华北理工大学附属骨科医院)手外科修复重建外科,河北唐山063000 [2]河北省儿童医院骨科,石家庄050000

出　　处：《中国修复重建外科杂志》2018年第12期1545-1548,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨拇指脱套伤截指术后采用Ilizarov技术重建拇指功能的疗效。方法 2011年6月—2016年9月,9例拇指脱套伤患者截指后应用Ilizarov技术重建拇指功能。男8例,女1例;年龄18～52岁,平均34.7岁。截指平面为掌指关节水平5例,掌指关节以近0.5～1.0 cm水平2例,近节指骨基底水平(近节指骨长度<1 cm)2例。截指术后患指较健侧指短缩4.0～7.5 cm,平均5.7 cm。术后第5天开始应用半环式外固定延长器延长,每天延长0.5 mm,每6小时延长1次。结果骨延长术后8例出现虎口抬高和挛缩,其中6例行拇指内在肌止点切断和虎口"Z"字成型术,术后拇指功能恢复良好;余2例拒绝手术。9例均获随访,随访时间14～47个月,平均33个月。骨延长时间64～122 d,平均86 d。骨延长长度3.0～5.9 cm,平均4.1 cm;平均延长长度为平均短缩长度的71.9%。外固定延长器固定时间169～342 d,平均231 d。愈合指数43.2～59.1 d/cm,平均为53.4 d/cm。1例出现延长段矿化延迟,行"手风琴"技术治疗后痊愈。患者均获骨性愈合,愈合时间169～342 d,平均231 d。无重新植骨内固定及掌指关节屈曲挛缩发生。延长指端的两点辨别觉与同水平健侧指相似;握力达健侧的53%～89%,捏力达健侧的59%～91%。结论应用Ilizarov技术行拇掌骨延长是拇指脱套伤截指后重建拇指功能的较好方法。Objective To investigate the effectiveness of Ilizarov technique in reconstruction of thumb functionin patients with thumb degloving injury after amputation. Methods Between June 2011 and September 2016, 9 cases ofthumb degloving injury were treated with amputation and Ilizarov technology. There were 8 males and 1 female with anage of 18-52 years (mean, 34.7 years). The amputation plane was the level of the metacarpophalangeal joint in 5 cases, thelevel of the proximal metacarpophalangeal joint in 2 cases, and the level of the base of the proximal phalanx in 2 cases (thelength of proximal phalanx was less than 1 cm). After amputation, the affected finger was shorter than the healthy fingerby 4.0-7.5 cm, with an average of 5.7 cm. On the fifth day after operation, the semi-loop external fixation extender wasapplied for extension, which was extended by 0.5 mm per day, and was extended once every 6 hours. Results After bonelengthening surgery, the first web space elevation and contracture occurred in 8 cases. Six of them were treated with theamputation of the inner muscle of the thumb and the "Z" forming technique, postoperative thumb function recoveredwell; the remaining 2 cases rejected plasty. All 9 patients were followed up 14-47 months, with an average of 33 months.Bone lengthening time was 64-122 days, with an average of 86 days. The lengthening length of bone was 3.0-5.9 cm, with anaverage of 4.1 cm, and the average lengthening length was 71.9% of the average shortened length. The fixation time ofexternal fixator was 169-342 days, with an average of 231 days. The healing index was 43.2-59.1 days/cm, with an averageof 53.4 days/cm. One case showed prolonged mineralization delay and recovered after "accordion" treatment. Bone healingwas finally achieved in all patients, with the healing time ranging from 169 to 342 days, with an average of 231 days. Noreplantation internal fixation and flexion contracture occurred. The two-point discrimination of extended fingertip wassimilar to that of normal fingertip. The gr

关 键 词：拇指功能重建 掌骨延长 ILIZAROV技术 脱套伤 

分 类 号：R658.2[医药卫生—外科学]