有限腱束切断联合静态支具治疗小儿轻中度前臂Volkmann挛缩的疗效分析  

Therapeutic efficacy of limited tenotomy plus static brace for mild-to-medium Volkmann's contracture of forearm in children

作　　者：韩明通[1] 张亮亮 赵振国[1] 张高峰 张磊[1] 韩清銮[1] 栗威[1] 王元会 Han Mingtong;Zhang Liangliang;Zhao Zhenguo;Zhang Gaofeng;Zhang Lei;Han Qingluan;Li Wei;Wang Yuanhui(Department of Hand&Foot Surgery,Affiliated Hospital,Jining Medical University,Jining 272000,China;College of Rehabilitation Medicine,Jining Medical University,Jining 272000,China)

机构地区：[1]济宁医学院附属医院手足外科,济宁272000 [2]济宁医学院康复医学院,济宁272000

出　　处：《中华小儿外科杂志》2023年第6期556-560,共5页Chinese Journal of Pediatric Surgery

基　　金：山东省自然科学基金资助项目(ZR2019MH100);山东省高等学校科技计划项目(J18KA267)。

摘　　要：目的探讨有限腱束切断联合静态支具固定治疗小儿轻中度Volkmann挛缩的临床效果。方法收集2015年7月至2022年1月在济宁医学院附属医院采用有限腱束切断联合静态支具固定治疗小儿轻中度Volkmann挛缩的11例患儿临床资料,其中男7例,女4例,年龄范围为6~12岁,中度前臂缺血性肌挛缩畸形2例,轻度前臂缺血性肌挛缩畸形9例。对11例轻、中度Volkmann挛缩致手指屈曲畸形患儿采用切断部分挛缩严重腱束的手术方法,术后白天进行功能训练,夜晚长期应用静态支具固定手指于伸直位。结果所有患儿术后切口愈合好,无切口并发症发生。患儿随访时间为6~20个月,平均随访时间13个月,均无明显屈曲畸形,无挛缩复发。腕关节功能位时,手指可完全伸直2例;腕关节中立位时,手指主被动完全伸直6例。按照中华医学会手外科学会上肢部分功能评定试用标准进行疗效评估,优2例,良9例。结论应用有限腱束切断联合静态支具治疗小儿轻中度Volkmann挛缩是一种简单、实用、有效的手术方式。Objective To explore the clinical efficacy of limited tenotomy plus static brace for mild-to-medium Volkmann's contracture of forearm in children.Methods Clinical data were retrospectively reviewed for 11 children with mild-to-medium Volkmann's contracture undergoing limited tenotomy plus static brace fixation from July 2015 to January 2022.There were 7 boys and 4 girls with an age range of(6-12)years.There were medium ischemic muscle contracture deformity of forearm(n=2)and mild ischemic muscle contracture deformity of forearm(n=9).Finger flexion deformity was managed by severing severely contracted tendon bundles.Functional postoperative training was performed during day and static brace utilized for fixing fingers in extended position at night.Results All children had excellent postoperative incision healing and there was no incision complication.During an average follow-up period of 13(6-20)months,there were no obvious flexion deformities or recurrent contractures.When wrist joint stayed in a functional position,fingers could be fully extended in 2 cases;In a neutral position,6 cases completed active and passive finger extensions.According to the trial criteria for upper limb function evaluation of Hand Surgery Society of Chinese Medical Association,the outcomes were excellent(n=2)and decent(n=9).Conclusions Limited tenotomy plus static brace are simple,practical and effective for mild-to-medium Volkmann's contracture in children.

关 键 词：前臂 缺血性肌挛缩 肌腱粘连松解 功能重建 

分 类 号：R726.5[医药卫生—儿科]