Ilizarov技术治疗外伤后拇指短缩或骨缺损  

Application of Ilizarov technique for thumb shortening or bone defects after trauma

作　　者：王斌[1] 郝睿峥[1] 王辉[1] 刘伟[1] 霍永鑫[1] 贾松[1] 韩彪 卢爱东[2] Wang Bin;Hao Ruizheng;Wang Hui;Liu Wei;Huo Yongxin;Jia Song;Han Biao;Lu Aidong(Tangshan Second Hospital (Affiliated Orthopaedic Hospital,North China University of Science and Technology)Hand Surgery,Reconstructive Surgery,Tangshan 063000,China;Kailuan General Hospital Ophthalmology,Tangshan 063000,China)

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,063000 [2]开滦总医院眼科,唐山063000

出　　处：《中华骨科杂志》2019年第1期52-57,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨Ilizarov技术治疗外伤后拇指短缩或骨缺损的疗效。方法回顾性分析2010年4月至2018年1月,采用Ilizarov技术治疗20例拇指短缩或骨缺损患者资料,男19例,女1例;年龄20~56岁,平均33.1岁;左侧15例,右侧5例;机器绞伤12例,压砸伤6例,交通伤2例。其中17例为创伤致截指短缩,截指平面分别为掌骨远端(9例)、近节指骨基底(6例)、指间关节(1例)、近节指骨远端(1例);1例为创伤后行指短缩融合,融合处未愈合致掌指关节缺损0.5 cm;2例为创伤后骨髓炎,病灶清除后形成指间关节缺损,分别为0.5 cm和0.7 cm。外伤后至行延长手术时间为10~159 d,平均72.7 d。20例患者均应用半环式外固定延长器治疗,其中掌骨截骨延长15例,近节指骨截骨延长5例。术后第5天开始延长,每天延长0.5 mm,每6 h延长一次。结果20例患者均获得随访,随访时间184~446 d,平均244.6 d;延长时间26~118 d,平均62.2 d;延长长度1.3~5.9 cm,平均3.1 cm。外固定延长器固定时间114~376 d,平均206.3 d。20例患者愈合指数43.7~ 84.1 d/cm,平均64.8 d/cm;牵开指数19.5~21.4 d/cm,平均20.1 d/cm;成熟指数39.4~110.1 d/cm,平均46.5 d/cm;外固定指数60~130.8 d/cm,平均66.5 d/cm。末次随访时,拇指恢复对指功能和感觉功能;按中华医学会手外科学会上肢部分评定试用标准中拇、手指再造功能评定试用标准进行评价:优11例,良9例,优良率100%(20/20 );两点辨别觉4~9 mm;患者对手指功能和外观均表示满意。结论 Ilizarov技术是治疗外伤后拇指短缩或骨缺损的良好方法,术后疗效优良。Objective To study the effect of Ilizarov technique on thumb shortening and bone defect after trauma.Methods The clinical data of 20 patients with thumb shortening or bone defect treated by Ilizarov technique from April 2010 to January 2018 were retrospectively analyzed. There were 19 males and 1 female including 15 left fingers and 5 right fingers. The age ranged from 20 to 56 years, with an average of 33.1 years. The osteotomy plane included 9 cases at distal part of the metacarpal, 6 cases proximal phalanx base, 1 case interphalangeal joint and 1 case distal part of proximal phalanx. Two cases were osteomyelitis after proximal and distal phalanges trauma, which resulted in interphalangeal joint defects after lesion clearance, and the length of the joint defect was 0.5 cm and 0.7 cm respectively. One case was emergency finger shortening fusion, which resulted in metacar-pophalangeal joint defect due to nonunion of fusion site, and the length of the joint defect was 0.5 cm. Causes of injury included mechanical strangulation (12 cases), crush injury (6 cases) and traffic injury (2 cases). Semi-ring external fixator was used to extend the extension. There were 15 cases of metacarpal bone osteotomy and 5 cases of proximal phalanx osteotomy, prolonged from the 5th day after surgery. The osteotomy was prolonged by 0.5 mm every day, once every 6 hours.Results The follow-up time ranged from 184 to 446 days with an average of 244.6 days. The average extension period was 62.2 days (26-118 days), and the average extension length was 3.1 cm (1.3-5.9 cm). The healing index was 43.7-84.1 d/cm and the average healing index was 64.8 d/cm. The external fixed extender was used for 114-376 days with an average of 206.3 days. The distraction index was 20.1 d/cm (range, 19.5-21.4 d/cm) and the maturity index was 46.5 d/cm (range, 39.4-110.1 d/cm) and the external fixation index was 66.5 d/cm (range, 60-130.8 d/cm). The finger pointing function and sensory function of thumb were restored after operation. According to the trial crite

关 键 词：拇指 伊利扎罗夫技术 外固定器 

分 类 号：R658[医药卫生—外科学]