屈肌起点滑移术治疗前臂缺血性肌挛缩

Sliding of the flexor muscles for treatment of Volkmann's contracture of the forearm

目的介绍屈肌起点滑移术治疗前臂缺血性肌挛缩的手术时机和疗效。方法作者为７例前臂缺血性肌挛缩作该手术。根据其病理演变过程和术中发现，将其临床分型归纳为６型。结果术中发现：前臂深层屈肌变性、挛缩较浅层屈肌严重。术后疗效为优者（Ｓ３Ｍ４）４例，良（Ｓ３Ｍ３）２例，可（Ｓ２Ｍ２）１例。手术时机以选择纤维化、挛缩期效果较好。在吸收再生期如神经损害在继续加重时也应手术。结论足够的肌起点剥离与适当的滑移距离，切除一切变性、坏死、挛缩的肌肉与筋膜，切开卡压神经的纤维索带、腕管与腕尺管。

Objective Timing and the outcome of the treatment of Volkmann's contracture of the forearm by sliding of the flexor muscles was introduced. Methods This procedure of flexor muscle sliding was appiled in 7 cases of Volkmann's contracture of the forearm. There were 6 males and one female,with ages ranged from 6～ 25 years ( on average 11 years old). The causes of the contracture were all malpractice. The intervals from injuries to the operation ranged from 2～4 months. Detachment of the common flexor pronator origin, excision of the degenerated and necrosed muscles, incision of the deep fascia, decompression of the nerves and sliding of the flexor muscles were the essential steps. Results Muscle degenerative contracture occured primarily in the middle third of the muscle belly of the forearm. The contracture was more severe in the deep flexors than in the superficial flexors. The median and ulnar nerve and the brachial artery were compressed by fibrotic and contractive tissues. After the operation, the result of 4 cases was excellent (S 3M 4), 2 good (S 3M 3) and one fair (S 2M 2). Conclusions Enough detachment of the common flexor pronator origin, thorough excision of the degenerated tissues, decompression of the nerves and release of carpal tunnel and Guyon's canal are key to the success of the operation. The operation should be done at the fibrotic and contracture period. Surgical intervention is also recommended if there are signs of neuropathy.