肱骨髁上骨折致Volkmann缺血性挛缩的早期处理

Early Management of Volkmann's Ischemic Contracture Complicated by Humeral Supracondylar Fracture

分析肱骨髁上骨折所致Ｖｏｌｋｍａｎｎ缺血性挛缩的；临床和手术所见，说明早期手术的重要性。对１９８４年５月～１９８７年５月在我院手术治疗的１５例肱骨髁上骨折所致Ｖｏｌｋｍａｎｎ缺血性挛缩进行系统回顾，随访９例，随访时间３～１０年。１４例由前臂间隔综合征引起。１２例脉搏存在，提示在该情况下手内在肌挛缩是由神经损伤引起。１３例行神经探查术，术中发现神经在骨折断端及其附近都有严重粘连、受压和变性，必须给以松解。随访９例，其中３例早期施行手术松解，获满意效果。结论：早期手术松解，同时行前臂挛缩肌延长术或动力肌的重新＂调整＂和坚持手内在肌被动操练，对其功能的恢复起重要作用。

To describe the clinical manifestations and operative findings of Volkmann's ischemic contracture following supracondylar fracture of the humerus and the importance of early surgical management,15 patients with Volkmann's ischemic contracture of forearm were treated surgieally from May 1984 to May 1987.All of them were reviewed and 9 were followed-up 3-10 years.In 14 cases resulted from compartment syndrome,the tadial pulse was present in 12 patients,It suggests that the intrinsic muscle contracture of the hand was caused by nerve injuries.In 13 operated cases,contriction ,adhesion and degeneration of the nerve were found in or around the fracture,Neurolysis was performed.Three of 9 cases that underwent early surgery obtained good results in the follow-up.An early neurolysis,proper treatment of muscle contracture and postoperative exercises,can help recovery of fu nction of the hand.