严重腕部电烧伤晚期手功能重建远期疗效分析  

Analysis of the long-term results of late hand function reconstruction in patients with severe electrical injury of the wrists

作　　者：徐靖宏[1] 李青峰[1] 陈守正[1] 程开祥[1] 王善良[1] 李圣利[1] 杨川[1] 周苏[1] 

机构地区：[1]第二医科大学附属第九人民医院整复外科,上海200011

出　　处：《中华烧伤杂志》2000年第6期328-330,共3页Chinese Journal of Burns

基　　金：卫生部基金! (96Q6 9);上海市科技发展基金!(96QB14 0 19)

摘　　要：目的　评价和分析现有各种腕部电烧伤后手功能晚期重建术式的远期疗效。　方法对 47例晚期腕部电烧伤病例所施形态修复和功能重建的疗效进行长期随访观察 ,并综合分析。　结果　在腕部皮肤组织修复和关节功能训练的基础上 ,以自体肌腱游离移植重建手屈指功能 ,疗效中等以上仅占 33.4%。 1例以吻合胫后动脉带小腿深筋膜的跖肌腱复合皮瓣修复腕部瘢痕、重建屈拇功能 ,疗程较短 ,术后粘连较轻。以自体游离神经移植修复正中神经和尺神经 ,术后无明显恢复分别占 72 .7%、81.8%。 2例以小隐静脉携带的腓肠神经、深筋膜复合组织移植修复病例 ,疗效尚需进一步观察。 3例结合术中逆向诱发电位判断神经近侧吻合面 ,疗效相对较好。　结论　移植物受床瘢痕化和血运差是肌腱移植和神经移植疗效不理想的重要原因 ,宜采用带血运的移植体周围组织改善植床血运 ,提高疗效。Objective To evaluate and analyze the long-term results of all the operation mordalities practised at present of late hand function reconstruction in patients with severe electrical injury of the wrists. Methods Forty-seven cases with late electrical injury of the wrists were followed up and comprehensively analyzed in terms of the long-term results of morphological reconstruction and functional restoration. Results In addition to cutaneous tissue repair and functional training of the joints of the wrists,the flexor digitorum reconstruction with auto free tendon grafting gave a poor result(only 33.4% of the cases with function above medium level).In one case, the wrist function was rebuilt by compound plantaris tendon free flap with leg deep facia and posterior tibial artery, resulting in the restoration of thumb flexor function,with shorter treating time and less postoperative adhesion.Median and ulnar nerves were repaired with free auto nerve grafting with no obvious effects.Two cases were repaired by compound tissue grafting of sural nerve and deep facia carried by small saphenous veins with uncertain result.In another 3 cases,with the aid of retrograde evoked potential (REP),a proximal anastomosis of nerves was done with fairly good result.ConclusionInsufficient blood supply and scar formation were the major causes of poor results of the tendon and nerve grafting.It was recommended that the graft should carry sufficient blood supply to improve the blood supply of the recipient bed in order to improve the therapeutic effects.The selection of proximal nerve segment should include the functional examination.

关 键 词：腕部电烧伤 手功能重建 皮瓣移植 骨移植 肌腱移植 神经移植 

分 类 号：R644[医药卫生—外科学]