利用尺侧腕伸肌腱重建蚓状肌功能的应用研究  

Using the extensor carpi ulnaris as the motor tendon in reconstruction of ulnar nerve palsy

作　　者：郭恩琪[1] 谢庆平[1] 王亮[1] 

机构地区：[1]浙江省人民医院手外科,杭州310014

出　　处：《中华显微外科杂志》2015年第5期443-446,共4页Chinese Journal of Microsurgery

基　　金：浙江省科技厅重大与高发疾病防治技术项目（2012C13020-3）

摘　　要：目的 探讨利用尺侧腕伸肌腱转位在蚓状肌功能重建、纠正爪形手畸形中的应用. 方法 2009年10月至2011年9月,对12例尺神经损伤后手内在肌麻痹伴爪形手畸形的患者,利用尺侧腕伸肌腱转位加掌长肌腱分束移植行第2～5指蚓状肌功能重建术.术后采用总主动活动度（Total Active Movement,TAM）系统、握力值和总体手功能DASH量表评分对患手功能做出评价. 结果 本组12例随访12 ～ 24个月,平均15.5个月.按总主动活动度系统评定法：本组术后手指主动屈、伸活动功能优4例,良6例,可2例.12例爪形手畸形均得到了矫正,术后患手平均握力较术前提高41％,差异有统计学意义（P＜0.05）.术后总体手功能DASH量表评分平均（20.4±6.8）分,较术前的平均（53.6±11.4）分有明显下降（P＜0.05）. 结论 利用尺侧腕伸肌腱进行蚓状肌功能重建且经术后指导功能锻炼,能有效纠正爪形手畸形,恢复伤手的部分主动捏物功能,在显著提高伤手握力的同时改善了总体手功能.尤其对伴正中神经损伤或功能下降的患者取得了良好效果.Objective To investigate the efficacy of using the extensor carpi ulnaris as the motor tendon in correcting claw hand deformity and improving hand function.Methods A total of 12 patients with ulnar nerve palsy and claw finger deformity were included into this study from October, 2009 to September, 2011.Results All ceses had an average followed-up of 15.5 months, ranging from 12 months to 24 months.According to the Total Active Movement （TAM） score, there were 4 cases receiving excellent results, 6 cases receiving good results and 2 cases receiving fair results.The claw finger deformity was corrected and intrinsic hand function improved significantly.The average increase in grip strength was 41% at the 12 months post operation, compared with the preoperative data （P 〈 0.05）.The mean DASH score decreased from 53.6 ± 11.4 preoperatively to 20.4 ± 6.8 postoperatively （P 〈 0.05）.Conclusion The technique of using the extensor carpi ulnaris as the motor tendon is effective in correcting claw fingers, increasing the grip strength and improving overall hand function.This surgical procedure is also beneficial for patients accompanied by the median nerve injury.

关 键 词：尺神经损伤 爪形手 尺侧腕伸肌腱 蚓状肌 功能重建 

分 类 号：R658.2[医药卫生—外科学]