前臂屈肌病变致手指屈曲挛缩的诊断与治疗

Diagnosis and treatment of finger flexion contracture caused by forearm flexor disease

目的总结3种前臂屈肌病变导致手指屈曲挛缩的临床特点、鉴别诊断和治疗方法。方法2008年12月—2021年8月收治17例手指屈曲挛缩患者,男8例,女9例;年龄5~42岁,中位年龄16岁。病程1.5个月~30年,中位时间13年。病因:缺血性肌挛缩6例,均为2~5指屈曲畸形,伴拇指背伸受限3例,腕关节背伸受限3例;假性缺血性肌挛缩3例,其中中、环、小指屈曲畸形2例,环、小指屈曲畸形1例;前臂屈肌病变或解剖变异引起的尺侧手指屈曲挛缩8例,均为中、环、小指屈曲畸形。行屈肌及旋前圆肌起点滑移、异常纤维带及骨刺切除、卡压肌肉(腱)松解等手术。术后采用王海华等的手功能评级标准或改良Buck-Gramcko分型标准评价患者手功能,参照英国医学研究会(MRC)肌力分级标准评价肌力。结果17例患者均获随访,随访时间1~10年,中位时间1.5年。末次随访时,8例前臂屈肌病变或解剖变异患者及3例假性缺血性肌挛缩患者功能评级均为优,肌力M5级6例、M4级5例;1例轻度缺血性肌挛缩患者及3例不伴有严重神经损害的中度缺血性肌挛缩患者手功能评级为优2例、良2例,肌力M5级1例、M4级3例;2例伴有严重神经损害的中度或重度缺血性肌挛缩患者手功能评级为差,肌力M3级1例、M2级1例,较术前有所改善。手功能总体优良率以及肌力M4级及以上患者比例均为88.2%(15/17)。结论结合病史、查体、影像学检查及术中所见鉴别不同病因引起的手指屈曲挛缩,通过挛缩带切除、卡压肌肉(腱)松解、屈肌起点下移等方法治疗后,可获得较好疗效。

Objectivee To summarize the clinical characteristics,differential diagnosis,and treatment methods of finger flexion contracture caused by three kinds of forearm flexor diseases.MethodsBetween December 2008 and August 2021,17 patients with finger flexion contracture were treated,including 8 males and 9 females,aged 5-42 years,with a median of 16 years.The disease duration ranged from 1.5 months to 30 years,with a median of 13 years.The etiology included 6 cases of Volkmann's contracture,all of which were flexion deformity of the 2nd to 5th fingers,accompanied by limitation of thumb dorsiflexion in 3 cases and limitation of wrist dorsiflexion in 3 cases;3 cases of pseudo-Volkmann's contracture,including 2 cases of flexion deformity of middle,ring,and little fingers,and 1 case of flexion deformity of ring and little fingers;8 cases of ulnar finger flexion contracture caused by forearm flexor disease or anatomical variations,all of which were flexion deformity of middle,ring,and little fingers.Operations such as slide of flexor and pronator teres origin,excision of abnormal fibrous cord and bony prominence,and release of entrapped muscle(tendon)were performed.Hand function was evaluated according to WANG Haihua's hand function rating standard or modified Buck-Gramcko classification standard,and muscle strength was evaluated according to British Medical Research Council(MRC)muscle strength rating standard.ResulstsAll patients were followed up 1-10 years(median,1.5 years).At last follow-up,8 patients with contracture caused by forearm flexor disease or anatomical variations and 3 patients with pseudo-Volkmann's contracture achieved excellent hand function,with muscle strength of grade M5 in 6 cases and grade M4 in 5 cases.One patient with mild Volkmann's contracture and 3 patients with moderate Volkmann's contracture without severe nerve damage had excellent hand function in 2 cases and good in 2 cases,with muscle strength of grade M5 in 1 case and grade M4 in 3 cases.Two patients with moderate or severe Volkmann's contracture had poor hand function,with 1 case of muscle strength of grade M3 and 1 case of grade M2,which improved when compared with those before operation.The overall excellent and good rate of hand function and the proportion of patients with muscle strength of grade M4 and above were 88.2%(15/17),respectively.Conclusion The finger flexion contracture caused by different etiology can be differentiated by analyzing the history,physical examination,radiographs,and intraoperative findings.After different surgical treatments,such as resection of contracture band,release of compressed muscle(tendon),and downward movement of flexor origin,most patients have a good outcome.