麻风病拇指爪形指及垂腕的生物力学研究及其康复治疗

Biomechanical Study and Rehabilitation on Leprosy Claw Thumb and Wrist Drop

目的通过对22例共27只麻风病后遗拇指爪形指及垂腕畸残手进行生物力学的定量实验研究方法,分析与上述畸残相关的拇指、腕掌关节背侧韧带、外侧韧带和掌侧韧带对关节稳定性所起的不同作用,为选择外科矫治方法提供科学依据。方法在X光机显示下通过生物学实验机对残肢的相应肌腱进行静态负荷测量,对所得到的各方向位移量进行统计分析。结果实验显示麻风病陈旧性爪形指及垂腕患者在屈拇、伸拇和外展运动中,背侧韧带及外侧韧带对关节稳定性的影响起主要作用。结论根据实验结果,在对这些患者开展外科矫治时采用部分桡侧伸腕长肌腱修复拇指掌腕关节韧带取代以往的拇指掌腕关节固定术,对术后功能的恢复及增强关节的稳定性效果明显。

Objective To provide the more reasonable rehabilitation treatment by the study on several ligaments responsible for claw thumb and wrist drop. Mthods 22 cured leprosy cases with 27 claw thumbs or/and wrist drops were studied by biomechanical test. Results Dorsal and lateral ligments played a key role in stabilizing the carpometacarpal joint when the thumb in flexing and abducting, while palmar ligment was more important for stabilizing joint when thumb was extended, the dorsal and palmar ligments were important for stabilizing the joint when the wrist joint was extended. All the 27 deformed hands were treated by repairing dorsal, lateral and palmar ligmenes and a satisfactory effect was obtained. Conclusion The claw thumb and wrist drop would be rehabilitated by repairing the dorsal, lateral and palmar ligments.