桡动脉鼻烟窝筋膜穿支皮瓣与骨间背动脉皮瓣修复虎口挛缩的比较

Thirty-five cases of contractures of the first web space repairing with snuffbox flap and the posterior interosseous artery flap

目的比较桡动脉鼻烟窝筋膜穿支皮瓣与骨间背动脉皮瓣修复虎121挛缩的效果。方法对2004年1月—2012年6月收治的35例创伤后虎口挛缩患者资料进行回顾性分析，其中采用桡动脉鼻烟窝筋膜穿支皮瓣重建虎口18例（A组），前臂骨间背动脉逆行岛状皮瓣重建虎口17例（B组）；比较2组术后患者皮瓣外观及存活情况，以物理测量评价临床疗效，对组内、组间数据进行统计学分析。结果患者均获随访6—18个月，平均12个月。35例皮瓣均成活。A组中2例远端部分浅表坏死，B组中有1例远端部分坏死、3例远端部分浅表坏死、1例桡神经深支部分损伤。术后6个月，A组虎口宽度增加（32．11±3．07）mm，虎口角增加58．78°±4．73°，AMA系统拇指功能损害值平均减少17．06％±5．35％；B组虎口宽度增加（31．71±2．57）mm，虎口角成人增加58．82°±3．76°，AMA系统拇指功能损害值平均减少15．96％±4．06％，与术前比较2组患者差异均有统计学意义（P值均〈0．01），但2组治疗前后变化的差异均无统计学意义（P值均〉0．05）。结论桡动脉鼻烟窝筋膜穿支皮瓣与骨间背动脉皮瓣修复虎口挛缩效果相近，但在操作简便性及安全性方面桡动脉鼻烟窝筋膜穿支皮瓣修复术略占优势。

Objective To investigate the therapeutic effects of two types of flaps repairing severe contractures of the first web space by retrospective study. Methods From January 2004 to June 2012, we operated 35 patients who were severe contractures of the first web space. There were 18 cases reconstructed with snuffbox flap （group A）, 17 cases were reconstructed with the posterior interosseous artery（PIA） flap （group B）. After operation, curative effects were evaluated by measuring hand＇s function and the first web space. All data were analyzed by statistics. Results All the patients were followed-up for a mean of 12 months （ranged from 6 to 18 months） . In group A, there were two cases partial superficial necrosis. In group B, there were three patients partial superficial necrosis, one patient distal partial necrosis, and one patient with secondary injury of deep branch of radial nerve, the width of first web space was augmented an average of （32. 11 ± 3.07） mm in group A and （31.71 ± 2.57） mm in group B, first web space was augmented an average of 58.78° ± 4.73° in group A and 58.82° ± 3.76° in group B, and evaluation of thumb function according to AMA system were improved 17.06% ± 5.35% in group A and 15.96% ± 4.06% in group B. There were no significant difference between group A and group B （ P 〉 0.05 ）. Conclusions Snuffbox flap is a prior selection than the PIA flap in reconstruction of first web space.