Woo Sang-Hyun, Lee Young-Keun, Lee Hang-Ho, Park Ji-Kang, Kim Joo-Yong, Dhawan Vikas
Woo & Lee's Institute for Hand Surgery and Reconstructive Microsurgery, W Hospital, 101-6 Gamsam-Dong, Dalseo-Gu, Daegu 704-902, South Korea.
Hand (N Y). 2009 Mar;4(1):55-61. doi: 10.1007/s11552-008-9141-z. Epub 2008 Oct 15.
The purpose of this study is to present our operative technique and postoperative results of the hand replantation with proximal row carpectomy in cases of complete amputation at the level of wrist joint. From May 2003 to April 2005, five patients suffered from complete amputation of the hand due to industrial trauma. Amputation level was radiocarpal joint in three cases and midcarpal joint in two cases. Three cases represented guillotine type and two cases with local crush type injuries. All were men and the mean age was 26.6 years. The mean follow-up period was 26.8 months. At the time of replantation, the wrist joint was stabilized with transarticular fixation using three to four Kirschner's wires after performing proximal row carpectomy. Postoperatively, functional results such as muscle strength, range of motion of the wrist and fingers, and sensory recovery were assessed according to Chen's criteria. Joint width and arthritic changes of the radio-capitate joint were evaluated with radiologic tools. According to Chen's criteria, the overall results in five cases were classified as grade II. Intrinsic muscle power of hands was found to be grade 4. The mean grip and pinch powers were 41% and 45%, respectively, compared to contralateral hand. The mean arc of flexion-extension of wrist was 53 degrees . Total mean active motion of fingers was 215 degrees. Static two-point discrimination of fingertip ranged from 8 to 13 mm. On the follow-up, computerized tomography showed well-preserved radio-capitate joint space without any arthritic changes. While performing hand replantation after amputation at the radiocarpal or midcarpal level, proximal row carpectomy is a useful procedure to preserve joint motion of the wrist in selected cases.
本研究的目的是介绍我们在腕关节水平完全离断病例中行近排腕骨切除术的手部再植手术技术及术后结果。2003年5月至2005年4月，5例患者因工业创伤导致手部完全离断。其中3例离断平面为桡腕关节，2例为腕中关节。3例为切割伤类型，2例为局部挤压伤类型。所有患者均为男性，平均年龄26.6岁。平均随访时间为26.8个月。再植时，在施行近排腕骨切除术后，用三到四根克氏针经关节固定来稳定腕关节。术后，根据陈式标准对手部肌肉力量、腕关节和手指活动范围以及感觉恢复等功能结果进行评估。用影像学工具评估桡头关节的关节间隙宽度和关节炎变化。根据陈式标准，5例患者的总体结果被评为II级。发现手部固有肌力量为4级。与对侧手相比，平均握力和捏力分别为41%和45%。腕关节屈伸平均弧度为53度。手指总主动活动度平均为215度。指尖静态两点辨别觉范围为8至13毫米。随访时，计算机断层扫描显示桡头关节间隙保存良好，无任何关节炎变化。在桡腕或腕中水平离断后进行手部再植时，近排腕骨切除术在特定病例中是一种有助于保留腕关节活动的有用手术。
