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[掌侧烧伤后掌骨与指骨牵引对手部瘢痕挛缩矫正效果的回顾性分析]

[Retrospective analysis of effects of metacarpus and phalanx traction on correction of scar contracture of hand after burn on the palm side].

作者信息

Chunsheng Hou, Qingye Liu, Hongfei Hao, Yuying Dong, Feng Wang, Jin Lei

出版信息

Zhonghua Shao Shang Za Zhi. 2015 Jun;31(3):172-6.


DOI:
PMID:26564562
Abstract

OBJECTIVE: To analyze the effects of metacarpus and phalanx traction on correction of scar contracture of hand after burn on the palm side retrospectively. METHODS: A total of 32 patients with 39 affected hands with scar contracture on the palm side after burn were hospitalized from May 2010 to December 2014. Method of treatment: scar contracture was conservatively released followed by skin grafting, which was referred to as method A; Kirschner wire was inserted into the middle or distal phalanx of finger with contracture and the corresponding metacarpus in the shape of U for 2 to 7 weeks' traction, which was referred to as method B; traction frame was built based on the traction pile and anchor formed by Kirschner wire inserted through the second to the fifth metacarpus and distal phalanx of finger with contracture, and then the affected fingers were pulled into a straight position with rubber bands for 2 to 6 months, which was referred to as method C. Method A was used in patients who would be treated with thorough release of scar followed by skin grafting routinely. Method B was used in patients who would be treated with intramedullary Kirschner wire fixation after release of scar contracture and skin transplantation routinely. Method C was further used in patients when methods A and B failed to accomplish the expected result. Method C was used in the first place followed by method A in whom there might be vascular decompensation or exposure of tendon and bone after scar release, and those who failed to meet the expectation were treated with method C in addition. Patients who were unwilling to undergo surgery were treated with method C exclusively. During the course of treatment, the presence or absence of infection and slipping of Kirschner wire or its slitting through soft tissue were observed. The presence or absence of tendency of recurrence of scar contracture within 1 to 2 weeks after treatment was observed. The length of palmar skin measuring from the root of finger with contracture to wrist crease was measured before treatment, at the termination of treatment, and 1 month after the termination of treatment. Scar condition was assessed with the Vancouver Scar Scale (VSS) before treatment and 1, 3, and 6 month(s) after the termination of treatment. Before treatment and 1 month after the termination of treatment, the range of motion was measured with the Total Active Movement (TAM) method; band function was evaluated by the Jebsen Test of Hand Function (JTHF), and the completion time was recorded. Data were processed with analysis of variance, LSD-t test, and t test. RESULTS: Twenty-four patients with 27 affected hands were treated with scheme A + B; 5 patients with 7 affected hands were treated with method C exclusively; 2 patients with 3 affected hands were treated with scheme A + B + C; 1 patient with 2 affected hands were treated with scheme C + A + C. During the course of treatment, no complication such as infection or slicing of tissue was observed, but there was a slight shifting of U-shaped Kirschner wire in 14 affected hands of 13 patients. Tendency of recurrence of scar contracture was observed in 11 affected hands of 10 patients, but the scar contracture did not reoccur after treatment with orthosis. The skin length of palmar side was respectively (131.8 ± 9.8) and (127.6 ± 7.5) mm at the termination of treatment and 1 month after, and they were both significantly longer than that before treatment [(114.5 ± 2.4) mm, with values respectively 10.71 and 10.39, P values below 0.001]. The score of VSS was respectively (9.8 ± 2.4), (9.7 ± 1.7), (9.3 ± 0.8), and (7.7 ± 0.5) points before treatment and 1, 3, and 6 month(s) after the termination of treatment. Only the score at 6 months after the termination of treatment was significantly lower than that before treatment (t = 3.28, P < 0.01). The ratio of excellent and good results according to method TAM was respectively 2.6% (1/39) and 94.9% (37/39) before treatment and 1 month after the termination of treatment. The time for JTHF measurement was (13.9 ± 4.1) min before treatment, and it was shortened to (11.0 ± 2.8) min 1 month after the termination of treatment (t = 3.65, P < 0.001). CONCLUSIONS: Single application of metacarpus and phalanx traction or its combination with skin transplantation after scar release in correcting scar contracture of the palm of hand after burn can lengthen the contracted tissue, and it is beneficial for the restoration of function and appearance of affected hand.

摘要

目的:回顾性分析掌骨和指骨牵引对矫正手掌侧烧伤后瘢痕挛缩的效果。 方法:选取2010年5月至2014年12月住院治疗的32例手掌侧烧伤后瘢痕挛缩患者,共39只患手。治疗方法:瘢痕挛缩保守松解后行植皮术,称为方法A;在挛缩手指的中节或末节指骨及相应掌骨以U形插入克氏针,进行2至7周的牵引,称为方法B;基于通过第二至第五掌骨及挛缩手指末节指骨插入的克氏针形成的牵引桩和锚构建牵引架,然后用橡皮筋将患指牵拉至伸直位2至6个月,称为方法C。方法A用于常规行瘢痕彻底松解后植皮的患者。方法B用于常规行瘢痕挛缩松解及皮肤移植后行髓内克氏针固定的患者。方法C在方法A和B未能达到预期效果时进一步用于患者。首先采用方法C,对于瘢痕松解后可能出现血管代偿失调或肌腱及骨外露的患者采用方法A,未达预期者加用方法C。不愿接受手术的患者仅采用方法C治疗。治疗过程中,观察有无感染、克氏针滑脱或其穿透软组织情况。观察治疗后1至2周内瘢痕挛缩有无复发倾向。在治疗前、治疗结束时及治疗结束后1个月测量从挛缩手指根部至腕横纹的手掌皮肤长度。在治疗前及治疗结束后1、3、6个月用温哥华瘢痕量表(VSS)评估瘢痕情况。在治疗前及治疗结束后1个月用总主动活动度(TAM)法测量活动度;用杰布森手功能测试(JTHF)评估手部功能,记录完成时间。数据采用方差分析、LSD-t检验和t检验进行处理。 结果:24例患者的27只患手采用方案A+B治疗;5例患者的7只患手仅采用方法C治疗;2例患者的3只患手采用方案A+B+C治疗;1例患者的2只患手采用方案C+A+C治疗。治疗过程中,未观察到感染或组织切割等并发症,但13例患者的14只患手克氏针出现轻微移位。10例患者的11只患手观察到瘢痕挛缩复发倾向,但经矫形器治疗后瘢痕挛缩未再出现。治疗结束时及治疗后1个月手掌侧皮肤长度分别为(131.8±9.8)mm和(127.6±7.5)mm,均显著长于治疗前[(114.5±2.4)mm,值分别为10.71和10.39,P值均<0.001]。VSS评分在治疗前及治疗结束后1、3、6个月分别为(9.8±2.4)、(9.7±1.7)、(9.3±0.8)和(7.7±0.5)分。仅治疗结束后6个月的评分显著低于治疗前(t=3.28,P<0.01)。根据TAM法,治疗前及治疗结束后1个月优、良率分别为2.6%(1/39)和94.9%(37/39)。JTHF测量时间治疗前为(13.9±4.1)分钟,治疗结束后1个月缩短至(11.0±2.8)分钟(t=3.65,P<0.001)。 结论:单纯应用掌骨和指骨牵引或其与瘢痕松解后植皮相结合在矫正烧伤后手掌瘢痕挛缩时可延长挛缩组织,有利于患手功能和外观的恢复。

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