Brenner P, Berger A, Axmann H D
Klinik für Plastische, Hand- und Wiederherstellungschirurgie, Medizinischen Hochschule Hannover im Krankenhaus Oststadt.
Unfallchirurg. 1991 May;94(5):267-73.
In established compartment syndrome discrimination between the different forms of flexion contracture, i.e., manifest Volkmann's contracture and intrinsic contracture is necessary. A combination of both is also possible. Classification is essential for determination of whether reconstruction is indicated and what procedure should be selected. Shortening osteotomies of the ulna and radius are now of historical interest only, as is carpalectomy. Lengthening of the flexor tendons is indicated only in mild and localized limited contracture of only some of the long fingers, but there is a danger of possible further adhesions limiting the range of motion. Thus, cases of stage I and II according to Tsuge with persisting partial flexor motor function are treated mainly by muscle sliding operation (Scaglietti) combined with microsurgery for internal neurolysis of the median and ulnar nerves. The latter is anteriorly transposed. In cases of solitary intrinsic contracture we prefer the Littler release procedure. The most useful repair in advanced compartment syndrome, however, consists in free microsurgical tissue transfer. The non-contractile, degenerated scarred flexor muscle remnants are excised and substituted orthotopic by transfer of free, neurovascular muscle, with salvage of flexor motor function in the forearm.
在已确诊的骨筋膜室综合征中，区分不同形式的屈曲挛缩，即明显的Volkmann挛缩和内在挛缩是必要的。两者合并出现的情况也有可能。分类对于确定是否需要进行重建以及应选择何种手术至关重要。尺骨和桡骨的缩短截骨术如今仅具有历史意义，腕骨切除术亦是如此。仅在部分长手指出现轻度和局限性的有限挛缩时才考虑延长屈肌腱，但存在进一步粘连限制活动范围的风险。因此，对于Tsuge分期为I期和II期且屈肌运动功能部分持续存在的病例，主要通过肌肉滑动手术（Scaglietti法）联合显微手术对正中神经和尺神经进行内部神经松解来治疗。后者向前移位。对于孤立的内在挛缩病例，我们更倾向于采用Littler松解术。然而，在晚期骨筋膜室综合征中，最有效的修复方法是游离显微组织移植。切除无收缩功能、变性瘢痕化的屈肌肌肉残余组织，通过游离神经血管肌肉移植进行原位替代，以挽救前臂的屈肌运动功能。
