Egerszegi E P, Zuker R M, Caouette-Laberge L, Manktelow R T, McLeod A M, Candlish S E, Garon N
Service de Chirurgie Plastique, Hôpital Sainte-Justine, Montréal, Québec, Canada.
Ann Chir. 1991;45(9):803-10.
Children are particularly prone to developing moderate to severe Volkmann's ischemic contracture following a supracondylar fracture of the humerus or its treatment. In order to treat such contractures, intensive hand therapy and a gracilis free muscle transfer to the digital flexors were used in 8 patients at an average age of 6 years 2 months. All transfers were successful. At follow-up (1 to 8 years, average 3 years), despite limited wrist extension in 5/8 patients and mean grip and pinch strengths between 22 and 43% of normal for age and dominance, all patients regained considerable finger flexor excursion (tip to crease distances of 0 to 5.0 cms, average 1.68 cms). Although fine motor assessment using the M.A.N.D. battery of tests placed the patients in the moderate disability range, 7/8 patients became independent in the tested activities of daily living with the exception of buttoning a cuff with the involved hand, which was difficult for 5/8 subjects. Quantifiable measurements underestimated the renewed importance of the operated hand. Compensatory motion at the shoulder allowed positioning the hand which changed from being nearly useless to becoming a functionally non-dominant hand well integrated into daily life.
儿童在肱骨髁上骨折或其治疗后特别容易发生中度至重度的Volkmann缺血性挛缩。为了治疗此类挛缩，对8名平均年龄为6岁2个月的患者采用了强化手部治疗以及将股薄肌游离肌肉转移至指屈肌的方法。所有转移均获成功。在随访期间（1至8年，平均3年），尽管8名患者中有5名存在腕关节伸展受限，且平均握力和捏力分别为同年龄和优势手正常水平的22%至43%，但所有患者的手指屈肌活动度均有显著恢复（指尖至掌横纹距离为0至5.0厘米，平均1.68厘米）。尽管使用M.A.N.D.测试组进行的精细运动评估将患者置于中度残疾范围内，但8名患者中有7名在测试的日常生活活动中实现了自理，不过用患手扣袖口对8名受试者中的5名来说仍有困难。可量化的测量低估了手术手重新获得的重要性。肩部的代偿性运动使手能够进行定位，手从几乎无用转变为功能上非优势但能很好融入日常生活的手。
