迷你外固定架牵张技术治疗创伤性虎口挛缩6例

Mini External Fixator Stretch Technique on the Treatment of 6 Patients with Traumatic Contracture of Tiger Mouth

目的:总结迷你外固定架牵张技术治疗创伤性虎口挛缩的手术方法和临床效果。方法:选取2019年1月至2022年6月收治的创伤性虎口挛缩患者6例作为研究对象,采用迷你外固定架牵张技术对其治疗。分别在第一、二掌骨近远端及拇示指近节中段确定3个进针点,避开血管、神经、肌腱,倾斜45°置入骨针,对骨针进行折弯,弯曲角度接近或等于90°,安装简易外固定撑开器,术后调整外固定撑开杆上的螺母,撑开过程中根据情况调整撑开的速度和维持的时间。统计患者治疗前后虎口角、虎口宽度及外固定松动失效、针道感染、关节脱位、医源性骨折、虎口区皮肤血供障碍及患指血运障碍等并发症情况。结果:所有患者术后均获得8~20个月随访,平均为13个月。戴架期间未出现外固定松动失效、针道感染、关节脱位、医源性骨折、虎口区皮肤血供障碍及患指血运障碍等并发症;末次随访时虎口角平均增大50°,虎口宽度平均增加35 mm,虎口均得到良好的撑开,拇指持物、捏物、外展、对掌的能力均得到明显改善。结论:迷你外固定架牵张技术操作简单,创伤小,疗效明确,是治疗创伤后虎口挛缩的有效方法。

Objective:To summarize the surgical methods and clinical efficacy of mini external fixator stretch technique on the treatment of traumatic tiger contracture.Methods:6 patients with traumatic tiger's mouth contracture treated from January 2019 to June 2022 were selected as the study objects and treated with mini external fixator stretch technique.Three insertion points were determined at the proximal distal end of the 1st and 2nd metacarpal bones and in the middle of the proximal segment of the thumb index finger,and the bone pins were placed at 45°tilt,avoiding blood vessels,nerves and tendons.The bone pins were bent at a bending angle close to or equal to 90°.A simple external fixation spinner was installed,and the nuts on the external fixation spinner were adjusted after surgery.The complications of tiger mouth angle,tiger mouth width and external fixation failure,needle tract infection,joint dislocation,iatrogenic fracture,skin blood supply disturbance and finger blood flow disturbance before and after treatment were analyzed.Results:All patients were followed up for 8 to 20 months with 13 months on average.There were no complications such as external fixation loosening failure,needle tract infection,joint dislocation,iatrogenic fracture,skin blood supply disorder in the tiger's mouth area and blood flow disorder in the affected finger.At the last follow-up,the average angle of the tiger mouth increased by 50°,the average width of the tiger mouth increased by 35 mm,the tiger mouth was well stretched,and the ability of thumb holding,kneading,abduction and palm were significantly improved.Conclusion:Mini external fixation and stretch technique is an effective method to treat post-traumatic contracture of tiger mouth with simple operation,little trauma and clear curative efficacy.