大鱼际肌失用性中重度虎口挛缩的治疗  

The trealment of the first web space contracture with muscle acinetatropbia of thenar

作　　者：薛明宇 芮永军 强力 沈小芳 华雍 施海峰 许亚军 

机构地区：[1]无锡手外科医院显微外科,江苏214062

出　　处：《中华手外科杂志》2015年第5期373-375,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨治疗大鱼际肌失用性中重度虎口挛缩的有效方法。方法自2008年7月至2014年3月，我们对21例因大鱼际肌失用造成中重度虎口挛缩的病例，在虎口开大、皮瓣覆盖的同时，利用环指浅屈肌腱或尺侧腕伸肌腱转位一期重建拇指对掌功能，并采用外固定支架将拇指维持在外展对掌位6周。结果术后16例获得3—18个月的随访，虎口距离平均增大3．86cm（3．12～4．30cm），虎口角度平均增大57°（30°～63°），拇指可与其他手指对指。随访6个月以上的13例患者均未出现虎口再次挛缩的现象。结论一期虎口开大并重建拇指对掌功能可提高大鱼际肌失用造成的虎口严重挛缩的治疗效果。Objective To discuss the effective treatment method for moderate to severe disuse contracture of the first web space. Methods Twenty-one cases of moderate to severe first web space eontracture as a result of thenar muscle disuse due to loss of thumb opposition were treated between July 2008 and March 2014. In addition to contracture release and coverage of the widened first web space with flap transfer, thumb opponensplasty was simultaneously done by transferring flexor digitorum superfieialis tendon from the ring finger or extensor carpi ulnaris. The thumb was maintained in opposition position with an external fixator for 6 weeks postoperatively. Results Postoperatively 16 patients were follow-up for 3 to 18 months. The width of the first web space was augmented an average of 3.86 em （range, 3.12 to 4.30 era）. The angle of the first web space was increased an average of 57°（range, 3°to 63°）. Thumb opposition was restored. No reeulTence of eontraetures of the first web spaee was seen in 13 cases that had longer than 6 months follow-up. Conclusion One stage eontraeture release and thumb opponensplasty is a reliable method to improve thumb opposition in patients with moderate to severe first web spaee eontraeture.

关 键 词：外科皮瓣 治疗结果 虎口挛缩 拇指对掌功能 

分 类 号：R619.6[医药卫生—外科学]