应用Ilizarov技术近节指骨与掌骨双截骨延长治疗拇指缺损  被引量:2

Application of double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique for thumb defect

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作  者:方均 王斌[1] 郝睿峥[1] 王伟[1] 贾松[1] 王丙刚[2] 宫中平[1] 张一 杨焕友[1] FANG Jun;WANG Bin;HAO Ruizheng;WANG Wei;JIA Song;WANG Binggang;GONG Zhongping;ZHANG Yi;YANG Huanyou(The First Department of Hand Surgery and Reconstructive Surgery,Tangshan Second Hospital(Affiliated Orthopaedic Hospital,North China University of Science and Technology),Tangshan Hebei,063000,P.R.China;The Fifth Department of Trauma Surgery,Tangshan Second Hospital(Affiliated Orthopaedic Hospital,North China University of Science and Technology),Tangshan Hebei,063000,P.R.China;Department of Orthopaedics,Affiliated Hospital of North China University of Science and Technology,Tangshan Hebei,063000,P.R.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)手一科/修复重建一科,河北唐山063000 [2]唐山市第二医院(华北理工大学附属骨科医院)创伤五科,河北唐山063000 [3]华北理工大学附属医院骨科,河北唐山063000

出  处:《中国修复重建外科杂志》2021年第8期989-993,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘  要:目的探讨采用Ilizarov技术行近节指骨与掌骨双截骨延长治疗拇指缺损的疗效。方法 2017年2月—2019年6月收治6例(6指)创伤性拇指缺损患者,均采用Ilizarov技术行近节指骨与掌骨双截骨延长。男5例,女1例;年龄28~57岁,平均41.5岁。左侧3例,右侧3例。伤后均急诊入院行拇指截指残端修整缝合术,截指平面分别为近节指骨远端4例、指骨间关节2例。受伤至该次延长术时间为20~245 d,中位数34.5 d。微创截骨并安置半环式外固定延长器,于术后第5天开始延长,近节指骨与掌骨每天同时分别延长0.5 mm,每12小时延长1次。待拇指延长至健侧拇指远节指骨中段时停止,达骨愈合后拆除延长器。结果 6例患者延长时间14~23 d,平均18.8 d;截骨完全愈合时间91~147 d,平均120.2 d;近节指骨与掌骨总延长长度1.40~2.25 cm,平均1.86 cm;愈合指数51.0~72.2 d/cm,平均64.9 d/cm。患者均获随访,随访时间5~12个月,平均8.2个月。末次随访时,拇指两点辨别觉为5.3~8.5 mm,平均6.98 mm。根据中华医学会手外科学会上肢部分功能评定试用标准评分为10~14分,平均12.5分;其中优4例、良2例,优良率100%。患者对手部功能和外观均满意,根据上肢功能评定表(Quick-DASH)评分为2.3~9.1分,平均6.1分。结论采用Ilizarov技术行近节指骨与掌骨双截骨延长是一种治疗拇指缺损的有效方法。Objective To investigate the effectiveness of double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique in treatment of thumb defect.Methods Between February 2017 and June 2019,6 patients with traumatic thumb defects were treated with double osteotomy and lengthening of proximal phalanx and metacarpal by Ilizarov technique.There were 5 males and 1 female.The age ranged from 28 to 57 years,with an average of41.5 years.There were 3 cases on the left side and 3 cases on the right side.All patients were admitted to the hospital in emergency department after injury,and the stump of the thumb was trimmed and sutured.The osteotomy plane was the distal part of the proximal phalanx in 4 cases and the interphalangeal joint in 2 cases.The interval between injury and osteotomy was 20-245 days(median,34.5 days).After minimally invasive osteotomy and placement of a semi-circular external fixator,the lengthening began on the 5 th day.The proximal phalanx and metacarpal were lengthened by 0.5 mm every day,once every 12 hours.The thumb of the affected side was distracted to the middle of the distal phalanx of the healthy thumb,and the fixator was removed after the bone healed.Results The distraction time was 14-23 days,with an average of 18.8 days.The osteotomies were healed with healing time of 91-147 days(mean,120.2 days).The total distraction length of the proximal phalanx and metacarpal was 1.40-2.25 cm,with an average of 1.86 cm;healing index was51.0-72.2 days/cm,with an average of 64.9 days/cm.All patients were followed up 5-12 months(mean,8.2 months).At last follow-up,the two-point discrimination was 5.3-8.5 mm with an average of 6.98 mm.According to the evaluation standard of the upper limb part of the Chinese Medical Association,the score was 10-14,with an average of 12.5.Among them,4 cases were excellent and 2 cases were good,with an excellent and good rate of 100%.All patients were satisfied with the function and appearance of thumb after operation.The Quick Disabilities of Arm,Shoulde

关 键 词:拇指缺损 ILIZAROV技术 双截骨延长 近节指骨 掌骨 

分 类 号:R658.2[医药卫生—外科学]

 

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