尺神经损伤后爪形手畸形矫治及功能重建.docVIP

尺神经损伤后爪形手畸形矫治及功能重建[摘要] 目的：探讨不同方法矫治尺神经损伤后爪形手畸形和功能重建。方法：对12例尺神经损伤后爪形手畸形，采用掌长肌腱反折移位11例，环指浅屈肌腱移位1例（其中示指固有伸肌腱→第一背侧骨间肌，重建示指外展功能1例）。结果：爪形指畸形矫正和功能重建优良率为91.6%（11/12）。结论：掌长肌腱移位等方法，是矫治尺神经损伤后爪形手畸形和重建功能简便、有效的方法。 [关键词] 尺神经；损伤；爪形指；矫正；重建 [中图分类号]R651.3 [文献标识码] B[文章编号] 1673-7210（2009）05（c）-141-02 The deformity correction and function reconstruction after ulnar nerve injuried with the clawing deformity WANG Fang1, ZHU Dongsheng1, CHEN Desong2, CHEN Fuqiang1, SHEN Shan’an1, GE Min1, PAN Zheng1 (1.Department of Orthopaedics, the Second People’s Hospital of Shanghai, Shanghai 200011, China; 2.Department of Hand Surgery, Huashan Affiliated Hospital of Fudan University, Shanghai 200040, China) [Abstract] Objective: To discuss various procedures of deformity correction and function reconstruction of the ulnar nerve injury with the clawing deformity. Methods: 12 cases of intrinsic muscles paralysis in the hand caused by ulnar nerve injury were corrected. The clawing deformity were treated by palmaris longus tendon reversal transfer in 11 cases, by ring superficial flexor tendon transfer in 1 case. Results: Correcting the clawing deformity and function reconstruction, the excellent and good rate was 91.6%(11/12). Conclusion: The palmaris longus tendon reversal transfer is a simple and valid method for correcting the clawing deformity and function reconstruction after the ulnar nerve injury. [Key words] Ulnar nerve; Injury; Claw finger; Correction; Reconstruction 近年来，我院对12例尺神经损伤后的爪形手畸形和功能障碍，采用掌长肌腱反折移位等不同方法进行矫治和重建功能，效疗满意，现总结如下： 1 资料与方法 1.1 一般资料 本组12例，其中，男9例，女3例；年龄17～62岁，平均28.6岁。尺神经损伤时间6个月～7年，神经功能无恢复，手的内在肌均明显萎缩，呈爪形手畸形。损伤原因为切割伤、挫伤、卡压等。前臂低位尺神经损伤5例，肘上高位尺神经损伤、内侧束损伤7例。采用掌长肌腱移位11例，环指浅屈肌腱移位1例（其中示指固有伸肌腱→第一背侧骨间肌，重建示指外展功能1例）。 1.2 手术方法 术前标记掌长肌腱位置。术中分别在前臂和腕横纹处做2个1 cm切口，找到掌长肌腱，向近端游离12～14 cm，前臂切口内(部分)切断，腕横纹切口内抽出，将掌长肌腱分成2股腱条。在掌指关节纹与远端掌横纹之间做一个3 cm平行掌部切口，然后将掌长肌腱反折后，经掌部皮下隧道于掌部切口抽出，再在环、小指掌指关节各做一个切口，以显露掌指关节远端的A1（或A2）滑车。将2 个腱条穿过A1（或A2）滑车后返折收紧，使环、小指掌指关节屈曲40°～50°，将返折后的肌腱条与腱条自身缝合。