应用外固定延长技术治疗虎口挛缩

Treatment of first web space contracture using lengthening technique with external fixator

目的探讨应用外固定延长技术治疗虎口挛缩的手术方法及疗效。方法2002年8月至2006年10月，使用外固定延长技术治疗虎口挛缩56例，40例有完整随访资料。男35例，女5例；年龄18~52岁，平均34岁；右手26例，左手14例。损伤原因：创伤性30例，烧伤性10例。依照顾玉东虎口挛缩分类方法（1986年）：中度挛缩25例，重度挛缩15例。拇指再造后2例。方法采用局麻或臂丛神经阻滞麻醉，在第一、二掌骨颈附近打入固定针，于掌骨间安放B-46型Orthofix微型外固定架。术后次日开始延长，每天1mm，分早、晚两次进行，延长至固定架的最大限度，时间为3．-4周。反复延长3次，后两次时间各为1周，最后维持在最大外展位2周。记录末次随访时虎口开大程度。结果40例患者获得随访，随访时间3～6个月，平均4个月。掌侧拇外展角度平均增大20°，拇指指间关节尺侧和示指掌指关节桡侧间距平均增加2．5cm。术后5例出现针道感染，4例发生第一腕掌关节半脱位，4例发生近节指骨尺偏畸形。结论使用外固定延长技术治疗虎口挛缩，方法简单，手术一次完成，治疗结果满意。

Objective To investigate the operative technique and clinical outcome of using lengthening technique with Orthofix minifixator system to keep the thumb in the desired position after simultaneous soft-tissue release for treatment of first web space. Methods Fifty-six cases diagnosed as first web space contracture were treated with the lengthening technique with external fixation from August 2002 to October 2006. Forty patients were followed up in detail. There were 35 males and 5 females, with average age of 34 years （range 18-52 years）. Twenty-six cases occurred in right hand, fourteen cases in left hand. The defect was caused by trauma in 30 patients, by burn in 10 patients. According to the classification criterion established by Gu （1986）, moderate contracture occurred in twenty-five cases, severe contracture in fifteen cases. After surgical release of the contracture, Orthofix minifixator （type B-46） pins were inserted into the first and second metacarpals at the level of nearby the first and second metacarpal neck. The external fixator served as a tool for gradual correction and to secure joint position after soft-tissue release. Lengthening progress started at the first day after operation with a speed of 1 mm/day until the maximal thumb abduction was ob- tained. The fixators were removed after six to eight weeks. The breadth of the thumb web space was measured and recorded at the last time of follow up. Results Forty cases of the patients were followed up for 3- 6 months with average 4 months. All patients experienced increased activity and improvement in grasping objects at follow-up evaluations. The thumb was in an average of 20 degrees of palmar abduction. The distance between the radial side of metacarpal phalangeal joint of the index finger and the ulnar side of interphalangeal joint of the thumb was enhanced to 2.5 cm. Pin site infection happened in five patients. Semidislocation of the first carpometacarpal joint occurred in four patients. Ulnar inclination deformity of the proximal phalanx of the thumb appeared in four patients. All were treated successfully. Conclusion Lengthening technique with external fixator is a simple and helpful method for the first web space contracture. It is safe, efficacious, and well tolerated.