作者：Chuan-Fong Yao, Yu-Te Lin, Chih-Hung Lin 文章發表：Taiwan Society for Plastic Surgery Journal, 2014,23(3) : 197-206
大綱：創傷後手掌虎口攣縮對手功能有明顯的負面影響。回顧性地探討一下我們在創傷後重度虎口攣縮手術放鬆後使用游離側臂皮瓣進行軟組織重建的經驗。方法：在1990年8月至2008年1月期間，對21例嚴重的虎口攣縮（術前掌指間角度小於30度）患者進行了手術放鬆，並進行了自由側臂皮瓣介入重建，然後置入交叉克氏針兩周以保持外展和環轉的虎口活動空間。測量掌骨間角和Kapandji評分。術後查訪期間，我們也記錄了手部抓力，手部功能主要的捏、掐紙張和以三角形合攏雙手的力量。通過電話採訪整理了一份針對特定手部的結果調查表-密歇根州“實際結果調查表”（MHQ）。結果：掌骨間角平均增加34度（p ＜0.001）。 Kapandji評分從術前中位數3提高到術後中位數6。至於術後手部力量測量，未受傷側顯示出更好的結果：平均握力（78.2磅VS 34.2磅，p ＜0.01）； 捏（19.3磅VS 8.7磅，p ＜0.01），掐紙張（14.6磅VS 7.1磅，p ＜0.01），以三角形合攏雙手的力量（16.8磅VS 7.8磅，p ＜0.05）。 MHQ的整體手功能，日常生活活動，工作，美學和滿意度均得到顯著改善。
結論：使用自由側臂瓣進行嚴重的創傷後手掌虎口攣縮有效地改善了對立功能和抓握範圍。由於先前已受傷，受傷手的握力不如未受傷側。
Background: Posttraumatic first web contracture has a significant negative effect on the hand function. Surgical release of the contracture followed by adequate soft tissue coverage is the cornerstone of treatment. Aim and Objectives: Retrospectively, we review our experience of using free lateral arm flap for soft tissue reconstruction after surgical release of posttraumatic severe first web contracture. Functional outcome evaluation was performed in this series. Materials and Methods: During August 1990 and January 2008, 21 patients with severe first web contracture (preoperative intermetacarpal angle less than 30 degrees) received surgical release with free lateral arm flap interpositioning reconstruction, followed by cross K-wires to keep the web space in abduction and circumduction for 2 weeks. Intermetacarpal angle and Kapandji score were measured. We also recorded the power of grip, key pinch, pulp pinch and tripod pinch in both hands by dynamometers during the postoperative follow-up. A hand-specific outcome questionnaire-Michigan Hand Outcome Questionnaire (MHQ) Chinese version was administered by telephone interview. Results: The average increase in intermetacarpal angle is 34 degree (p＜0.001). The Kapandji score improves from the preoperative median 3 to postoperative median 6. As for the power measurement postoperatively, the uninjured side showed better results: average grip power (78.2 pounds VS 34.2 pounds, p＜0.01); key pinch (19.3 pounds VS 8.7 pounds, p＜0.01), pulp pinch (14.6 pounds VS 7.1 pounds, p＜0.01), tripod pinch (16.8 pounds VS 7.8 pounds, p＜0.05). The overall hand function, activities of daily living, work, aesthetics and satisfaction score of MHQ improved significantly. Conclusion: The use of free lateral arm flap for severe posttraumatic first web contracture effectively improves the opposition function and span of grasp. Due to the pre-existing injuries, the grip power of the injured hand is inferior to the uninjured side.
Comments