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-  2018 

Ilizarov 技术在拇指脱套伤截指术后功能重建中的应用

DOI: doi:10.7507/1002-1892.201803047

Keywords: 拇指功能重建, 掌骨延长, Ilizarov 技术, 脱套伤

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Abstract:

目的探讨拇指脱套伤截指术后采用 Ilizarov 技术重建拇指功能的疗效。方法2011 年 6 月—2016 年 9 月,9 例拇指脱套伤患者截指后应用 Ilizarov 技术重建拇指功能。男 8 例,女 1 例;年龄 18~52 岁,平均 34.7 岁。截指平面为掌指关节水平 5 例,掌指关节以近 0.5~1.0 cm 水平 2 例,近节指骨基底水平(近节指骨长度<1 cm)2 例。截指术后患指较健侧指短缩 4.0~7.5 cm,平均 5.7 cm。术后第 5 天开始应用半环式外固定延长器延长,每天延长 0.5 mm,每 6 小时延长 1 次。结果骨延长术后 8 例出现虎口抬高和挛缩,其中 6 例行拇指内在肌止点切断和虎口“Z”字成型术,术后拇指功能恢复良好;余 2 例拒绝手术。9 例均获随访,随访时间 14~47 个月,平均 33 个月。骨延长时间 64~122 d,平均 86 d。骨延长长度 3.0~5.9 cm,平均 4.1 cm;平均延长长度为平均短缩长度的 71.9%。外固定延长器固定时间 169~342 d,平均 231 d。愈合指数 43.2~59.1 d/cm,平均为 53.4 d/cm。1 例出现延长段矿化延迟,行“手风琴”技术治疗后痊愈。患者均获骨性愈合,愈合时间 169~342 d,平均 231 d。无重新植骨内固定及掌指关节屈曲挛缩发生。延长指端的两点辨别觉与同水平健侧指相似;握力达健侧的 53%~89%,捏力达健侧的 59%~91%。结论应用 Ilizarov 技术行拇掌骨延长是拇指脱套伤截指后重建拇指功能的较好方法

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