前臂中段离断伤再植保留手功能及加强肌力的方法

Preservation of hand function and enhancement of muscle strength in replantation of severed mid-forearm

目的 探讨前臂中段离断伤再植保留手功能及加强肌力的方法。方法 断肢再植时将离断肢体以远失神经支配的肌肉组织切除 ,切取髂胫束条桥接远端肌腱和近端肌肉组织 ,并桥接肱二头肌加强屈腕屈指 ,桥接肱三头肌加强伸腕伸指功能 ,同时完好地接神经 ,以恢复手的感觉和手内在肌肌力。结果 共治疗 4例 ,术后随访 19个月～ 2 8个月 ,平均 2 4个月。平均肌力 :屈腕屈指M4 ;伸腕伸指M4 。腕平均活动度 :屈腕 6 0°,伸腕 48°,桡偏 2 0°,尺偏 40°,手指总活动度 (TAM) 2例属优 ,2例属良 ,TAM >80 %。手部感觉恢复至S3 ～S3 + 。

Objective To explore the methods of preservation of hand function and enhancement of muscle strength in replantation of severed mid forearm. Methods Denervated muscles distal to severed limb were resected. Iliotibial tracts were harvested to bridge the distal tendons and the proximal muscles. Bridgement of brachial biceps and brachial triceps were done to enhance flexion and extension of wrist and finger respectively. Results 4 patients were involved in this study. The follow up period ranged from 19 months to 28 months, with an average of 24 months. The average muscle strength of flexion and extension of wrist and fingers were graded M 4 .Range of motion was as follows:wrist flexion of 60° extension of 48° radial deviation of 20° and ulnar deviation of 40°. The overall movement of the digits (TAM)( > 80 %) was checked, with 2 cases excellent and 2 cases good. The sensation of the hands was restored to S 3～S 3+ . Function of pinch ,grasp was achieved nearly normal due to restoration of intrinsic muscle power. Conclusion The procedure was effective on preservation of hand function.