摘要
目的探讨腹部双蒂真皮下血管网皮瓣联合内固定治疗合并骨折的手指远节软组织挫灭伤的临床疗效。方法2013年6月至2017年8月,我院收治30例(30指)手指远节软组织挫灭伤合并远节指骨骨折的患者。男17例,女13例;年龄23~50岁,平均42岁;受伤原因:绞伤15例,压砸伤11例,爆炸伤4例;受伤指别:拇指11例,示指9例,中指6例,环指4例;受伤至手术时间2~4 h,平均2.7 h。均采用克氏针固定远节指骨,腹部双蒂真皮下血管网皮瓣瓦合修复手指背侧及掌侧创面,术后4周断蒂。结果本组皮瓣全部成活,创面全部I期愈合,骨折全部Ⅰ期愈合,患者全部获得随访,随访时间12~24个月,平均19.5个月。皮瓣外观及色泽满意,感觉恢复S1级17例,S2级9例,S3级4例。末次随访时,根据中华医学会手外科学会上肢部分功能评定试用标准评定手指功能,优26例,良3例,可1例,优良率96%。结论腹部双蒂真皮下血管网皮瓣联合内固定可有效覆盖创面及固定骨折,恢复手指运动及部分感觉功能,是一种安全有效的治疗方法。
Objective To investigate clinical effects of abdominal double-pedicle subcutaneous vessel plexus flaps combined with internal fixation in the treatment of soft tissue contusions with distal phalange fractures.Methods Thirty patients(30 fingers)with soft tissue contusions and distal phalange fractures were analyzed from June 2013 to August 2017.There were 17 males and 13 females with an average age of 42 years(range:23-50 years).Causes of injury:15 cases of wringing injury;11 cases of crush injury;4 cases of explosion injury.Injured fingers:11 cases of the thumb;9 cases of the index finger;6 cases of the middle finger;4 cases of the ring finger.The time from injury to surgery ranged 2-4 h,with an average of 2.7 h.The distal phalanges were fixed with kirschner wires,and the dorsal and palmar wounds were repaired by the abdominal double-pedicle subcutaneous vessel plexus flaps.The pedicles were broken 4 weeks after surgeries.Results All flaps were alive.Primary healing was achieved in all the wounds and fractures.All patients were followed up for 12-24 months with an average of 19.5 months.The appearance and color of the flaps were satisfactory,and the sensation was restored in 17 cases of grade S1,9 cases of grade S2,and 4 cases of grade S3.Finger functions were assessed according to the criteria of upper limb function evaluation of the hand surgery society of the Chinese medical association at the last follow-up.There were 26 excellent cases,3 good cases and1 fair case with an excellent rate of 96%.Conclusions Abdominal double-pedicle subcutaneous vessel plexus flaps combined with internal fixation can effectively cover the wound,fix the fracture,and restore the finger movement and part of sensory functions.
作者
周彤
张净宇
于志亮
张文龙
于俊
董惠双
张万喜
于亚东
高顺红
ZHOU Tong;ZHANG Jing-yu;YU Zhi-liang;ZHANG Wen-long;YU Jun;DONG Hui-shuang;ZHANG Wan-xi;YU Ya-dong;GAO Shun-hong(Department of Hand Surgery,The Sencond Hospital of Tangshan,Hebei,063000,China)
出处
《中国骨与关节杂志》
CAS
2020年第8期618-621,共4页
Chinese Journal of Bone and Joint
关键词
指骨
骨折
内固定术
外科皮瓣
创伤和损伤
手
Finger phalanges
Fracture
Fixation,internal
Surgical flaps
Wounds and injuries
Hand
