烧伤后爪形手畸形的整复

Repair of claw hand deformity after burn

目的探讨烧伤后爪形手畸形的整复方法。方法1992年5月～2007年5月，笔者对97例（136只患手）烧伤后爪形手畸形患者进行手术整复，患手中，轻度畸形21只、中度92只、重度23只；手背创面植皮修复104只患手，皮瓣转移修复32只患手。掌指关节复位在手背部瘢痕组织充分松解后主要采用手法拔伸牵引复位，必要时松解侧副韧带、背侧关节囊和分离关节内粘连，肌腱挛缩明显者行肌腱延长术：手背瘢痕松解整复后根据情况行手指屈曲畸形整复、指蹼和虎口粘连松解植皮、指伸肌腱中央腱修复或指间关节融合术。31例患者因手指屈曲畸形严重，阻碍掌指关节复位，先行手指掌侧瘢痕松解植皮，再行手背瘢痕松解、掌指关节复位、皮瓣转移或植皮。术后采取综合康复治疗措施．结果术后皮片全部成活；4只患手皮瓣远端边缘因瘢痕组织部分坏死，换药后愈合，其余皮瓣完全成活。患手绝大部分关节畸形完全或基本纠正，对掌、握拳功能恢复或部分恢复，效果较为满意。结论个性化、系统全面地进行皮片移植和皮瓣转移是整复烧伤后爪形手的关键。

Objective To summarize methods for repair of claw hand deformity after burn. Methods Ninety-seven patients with 136 claw hands after burn hospitalized from May 1992 to May 2007 were repaired with skin grafting（ 104 hands） and transposition of skin flap （ 32 hands） , among which 21 hands were minorgrade,92 hands moderate,23 hands severe. The metacarpophalangeal joint was repaired after scar release in dorsum of hand with manual extraction reduction, release of collateral ligament and joint capsula, separation of adhesion in joint, tendon lengthening for obvious contracture. Restitution of finger flexion deformity, lysis of adhesion and grafting among first web and finger webs, repair of central slip extensor tendon or phalangeal arthrudesis were performed according to the abnormal condition after lysis of dorsal scar of hand. The metacarpophalangeal joint from 31 patients were not repaired with above methods for severe finger flexion deformity ,their palmar scar were loosened and transplanted firstly, then scar in dorsum of hand were loosened, metaearpophalangeal joint were repaired, flap or skin were transferred or transplanted. General rehabilitation were performed routinely after operation. Results The ending of flaps（4 hands） due to the scar were nec- rosis after transposition and healed through dressing change, other skins or flaps all survived. Most articular deformities were corrected completely or basically, Functions including palmar opposition , grasp were also recovered with satisfactory results. Conclusion Skin transplantation and transfering of skin flap with overall planning and individual isation are the key points for repair of claw hand after burn.