摘要
目的评估大鱼际肌爆炸伤的分型及疗效。方法１９８０年以来，共收治１６２例大鱼际肌爆炸伤，按其损伤程度分为三型，Ⅰ型：损伤限于肌肉表面，仅作清创缝合即可。Ⅱ型：损伤深达肌肉内，软组织缺损较大时，用皮瓣或游离皮片植皮并修复虎口。Ⅲ型：损伤累及深层的掌骨与关节，常伴有拇指血供丧失和肌肉坏死，以往拇指均作截指术。１９８９年起采用掌浅、深弓转移重建拇指血供。掌长肌腱移位重建拇外展功能，创面用皮瓣覆盖。结果Ⅰ型９７例手功能恢复基本正常。Ⅱ型３９例大鱼际肌肌力４级，拇指对掌功能尚满意。Ⅲ型２６例中，２１例行拇指截指术，重建血供的５例随访２～８年，拇指指腹两点辨别觉为６～１０ｍｍ，拇对掌功能恢复较为满意。结论大鱼际肌爆炸伤根据其分型采取合理的治疗措施。
Objective To study the prognosis and classification of explosive wounds of the thenar muscles. Methods Since 1980, 162 cases of explosive wounds of the thenar muscles were treated. According to the severity of injuries, explosive wounds of the thenar muscles were divided into three types. Type 1: wounds superficial to the muscles (97 cases); Type 2: wounds within the thenar muscles with soft tissue defect ( 39 cases); Type 3: deep wounds involving the bone and the joint usually with compromised blood supply of the thumb and necrosis of muscles ( 26 cases).Debridement and primary suture were performed for wounds of type 1, and free or pedicled skin flaps were used for wounds of type 2. As to wounds of type 3, amputation and late stage thumb reconstruction was performed on 21 cases, whereas in last 5 cases ,blood supply and abduction of thumbs were restored with transfer of superficial or deep palmar arch and tendon of palmaris longus muscle. The first web was also repaired. Results Type 1: hand function was restored nearly to normal; type 2: the muscle strength reached MRC 4 with satisfactory oppones function; type 3: all 5 cases with vascular reconstruction showed satisfactory oppones function and 6～10mm of two point discrimination after 2～8 year's follow up. Conclusion The classification could assess the prognosis and guide treatment of explosive wounds of the thenar muscles.
出处
《中华手外科杂志》
CSCD
1998年第2期106-107,共2页
Chinese Journal of Hand Surgery
关键词
手
创伤
损伤
显微外科手术
大鱼际肌
爆炸伤
Hand Muscle,skeletal Wounds and injuries Classification Microsurgery
