中国修复重建外科杂志

中国修复重建外科杂志

Ilizarov 技术在拇指脱套伤截指术后功能重建中的应用

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目的探讨拇指脱套伤截指术后采用 Ilizarov 技术重建拇指功能的疗效。方法2011 年 6 月—2016 年 9 月,9 例拇指脱套伤患者截指后应用 Ilizarov 技术重建拇指功能。男 8 例,女 1 例;年龄 18~52 岁,平均 34.7 岁。截指平面为掌指关节水平 5 例,掌指关节以近 0.5~1.0 cm 水平 2 例,近节指骨基底水平(近节指骨长度<1 cm)2 例。截指术后患指较健侧指短缩 4.0~7.5 cm,平均 5.7 cm。术后第 5 天开始应用半环式外固定延长器延长,每天延长 0.5 mm,每 6 小时延长 1 次。结果骨延长术后 8 例出现虎口抬高和挛缩,其中 6 例行拇指内在肌止点切断和虎口“Z”字成型术,术后拇指功能恢复良好;余 2 例拒绝手术。9 例均获随访,随访时间 14~47 个月,平均 33 个月。骨延长时间 64~122 d,平均 86 d。骨延长长度 3.0~5.9 cm,平均 4.1 cm;平均延长长度为平均短缩长度的 71.9%。外固定延长器固定时间 169~342 d,平均 231 d。愈合指数 43.2~59.1 d/cm,平均为 53.4 d/cm。1 例出现延长段矿化延迟,行“手风琴”技术治疗后痊愈。患者均获骨性愈合,愈合时间 169~342 d,平均 231 d。无重新植骨内固定及掌指关节屈曲挛缩发生。延长指端的两点辨别觉与同水平健侧指相似;握力达健侧的 53%~89%,捏力达健侧的 59%~91%。结论应用 Ilizarov 技术行拇掌骨延长是拇指脱套伤截指后重建拇指功能的较好方法。

ObjectiveTo investigate the effectiveness of Ilizarov technique in reconstruction of thumb function in patients with thumb degloving injury after amputation.MethodsBetween June 2011 and September 2016, 9 cases of thumb degloving injury were treated with amputation and Ilizarov technology. There were 8 males and 1 female with an age of 18-52 years (mean, 34.7 years). The amputation plane was the level of the metacarpophalangeal joint in 5 cases, the level of the proximal metacarpophalangeal joint in 2 cases, and the level of the base of the proximal phalanx in 2 cases (the length of proximal phalanx was less than 1 cm). After amputation, the affected finger was shorter than the healthy finger by 4.0-7.5 cm, with an average of 5.7 cm. On the fifth day after operation, the semi-loop external fixation extender was applied for extension, which was extended by 0.5 mm per day, and was extended once every 6 hours.ResultsAfter bone lengthening surgery, the first web space elevation and contracture occurred in 8 cases. Six of them were treated with the amputation of the inner muscle of the thumb and the "Z" forming technique, postoperative thumb function recovered well; the remaining 2 cases rejected plasty. All 9 patients were followed up 14-47 months, with an average of 33 months. Bone lengthening time was 64-122 days, with an average of 86 days. The lengthening length of bone was 3.0-5.9 cm, with an average of 4.1 cm, and the average lengthening length was 71.9% of the average shortened length. The fixation time of external fixator was 169-342 days, with an average of 231 days. The healing index was 43.2-59.1 days/cm, with an average of 53.4 days/cm. One case showed prolonged mineralization delay and recovered after "accordion" treatment. Bone healing was finally achieved in all patients, with the healing time ranging from 169 to 342 days, with an average of 231 days. No replantation internal fixation and flexion contracture occurred. The two-point discrimination of extended fingertip was similar to that of normal fingertip. The grip strength reached 53%-89% of the healthy side; the kneading force reached 59%-91% of the healthy side.ConclusionThe application of Ilizarov technology to extend the thumb metacarpal lengthening is a good method to reconstruction the thumb function after degloving injury.

关键词: 拇指功能重建; 掌骨延长; Ilizarov 技术; 脱套伤

Key words: Thumb reconstruction; metacarpal lengthening; Ilizarov technology; degloving injury

引用本文: 王斌, 王辉, 孟钊, 刘伟, 郝睿峥, 张荐, 霍永新, 陈超, 贾松. Ilizarov 技术在拇指脱套伤截指术后功能重建中的应用. 中国修复重建外科杂志, 2018, 32(12): 1545-1548. doi: 10.7507/1002-1892.201803047 复制

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