Buck-Gramcko D, Fry C
Abteilung für Handchirurgie und Plastische Chirurgie, Berufsgenossenschaftlichen Unfallkrankenhauses Hamburg.
Handchir Mikrochir Plast Chir. 1991 May;23(3):128-43.
Results of long-term follow up of 66 patients with ischemic contracture of the forearm and hand, all surgically treated in the "Unfallkrankenhaus Hamburg)) between 1961 and 1982, are presented. Whereas ischemic contracture of the forearm flexors resulted mainly from fractures, ischemic contracture of the intrinsic muscles of the hand was most often seen after pressure injuries. All patients in this study presented to us with fully established ischemic contractures. Muscle and nerve damage was retrospectively evaluated according to operative notes, and the degree of damage could be classified into four groups. Most frequently, neurolysis, scar excision and muscle-sliding operations were performed; furthermore, tendon lengthening, tendon transpositions, wrist arthrodesis and nerve grafting were indicated. Results were judged according to twelve separately measured functions, each measurement giving a possible score of three to six points. Muscle-sliding operations result in an improved score regardless of ischemic contracture stage. For a stage 2 contracture, a 20 point improvement can be expected. In stage 1 contracture--presenting with extension deficiency of four or more points--, complete recovery can be expected following a muscle-sliding operation. For isolated muscle injuries, tendon lengthening is recommended. For stage 2 contracture, the transposition of superficial to deep flexor tendons results in the same score as a muscle-sliding operation; however, the transposition procedure should be reserved for special indications. In stage 3 contracture, the muscle-sliding operation is the treatment of choice, with secondary procedures such as tendon transpositions and nerve grafts often being necessary. In stage 4 ischemic contracture, muscle-sliding operations may improve extension deficiency; however, wrist arthrodesis, especially in combination with extensor tendon transpositions, may be beneficial. No experience with free muscle transplantation was made during the study period.
本文呈现了66例前臂和手部缺血性挛缩患者的长期随访结果，这些患者均于1961年至1982年间在“汉堡创伤医院”接受了手术治疗。前臂屈肌的缺血性挛缩主要由骨折引起，而手部内在肌的缺血性挛缩最常见于压迫伤后。本研究中的所有患者就诊时缺血性挛缩均已完全形成。根据手术记录对肌肉和神经损伤进行回顾性评估，损伤程度可分为四组。最常进行的手术是神经松解、瘢痕切除和肌肉滑动术；此外，还需进行肌腱延长、肌腱移位、腕关节融合和神经移植。根据十二项分别测量的功能来判断结果，每项测量的可能得分为3至6分。无论缺血性挛缩处于何种阶段，肌肉滑动术均可提高得分。对于2期挛缩，预计可提高20分。对于1期挛缩（表现为伸展不足4分或更多），肌肉滑动术后有望完全恢复。对于孤立的肌肉损伤，建议进行肌腱延长。对于2期挛缩，浅屈肌腱向深屈肌腱的移位与肌肉滑动术的得分相同；然而，移位手术应保留用于特殊指征。对于3期挛缩，肌肉滑动术是首选治疗方法，通常还需要进行肌腱移位和神经移植等二次手术。对于4期缺血性挛缩，肌肉滑动术可能改善伸展不足；然而，腕关节融合术，尤其是与伸肌腱移位联合应用时，可能有益。在研究期间未进行游离肌肉移植的经验。
