中重度前臂缺血性肌肉挛缩晚期功能重建的手术治疗

Late functional reconstruction of moderate to severe Volkmann contracture

目的探讨中、重度前臂缺血性肌肉挛缩晚期功能重建的手术方法及疗效。方法对42例中、重度前臂缺血性肌肉挛缩的晚期患者,进行旋前畸形矫正和旋后对掌功能重建手术。其中6例行指浅、深屈肌腱交叉延长术,17例行肌腱转位术+骨间膜、旋前方肌松解术,19例行肌腱转位术+骨间膜、旋前方肌松解术+腕屈肌旋后功能重建术。结果术后42例患者均获得6～34个月的随访。旋后功能恢复:优9例,良18例,可12例,差3例,优良率为64.3%。手功能恢复:优11例,良15例,可14例,差2例,优良率为61.9%。结论对中、重度晚期缺血性肌肉挛缩的患者,应针对其不同的挛缩程度采用不同的手术方法进行治疗。

Objective To introduce the surgical procedures of functional reconstruction for moderate to severe Volkmann contracture and evaluate the treatment outcomes. Methods Forty-two patients with moderate to severe Volkmann contracture were surgically treated to improve the forearm function. Cross lengthening of flexor digitorum superficialis and profundus was done in 6 cases. In 17 cases, tendon transfer, interosseous membrane release and prenator quadratus release were done. The other 19 cases in addition to tendon transfer and release of the interosseous membrane and prenator quadratus, supination of the forearm was restored with flexor carpi ulnaris transfer. Results The postoperative follow-up ranged from 6 to 34 months. Forearm and hand fimction was evaluated. Supination was graded as excellent in 9 cases, good in 18 cases, fair in 12 cases and poor in 3 cases. The excellent and good rate was 64.3%. Hand function was graded as excellent in 11 cases, good in 15 cases, fair in 14 cases and poor in 2 cases. The excellent and good rate was 61.9%. Conclusion To patients with moderate to severe Volkmann contracture, different surgical procedures should be chosen depending on severity of the contracture to improve functional recovery.