Nayak S, Lenka P K, Equebal A, Biswas A
National Institute for the Orthopaedically Handicapped, Under Ministry of Social Justice and Empowerment, Government of India, B-T Road, Bon Hooghly, 700090 Kolkata, India.
National Institute for the Orthopaedically Handicapped, Under Ministry of Social Justice and Empowerment, Government of India, B-T Road, Bon Hooghly, 700090 Kolkata, India.
Hand Surg Rehabil. 2016 Sep;35(4):299-303. doi: 10.1016/j.hansur.2016.05.004. Epub 2016 Jul 21.
Up to now, a cosmetic glove was the most common method for managing transmetacarpal (TMC) and carpometacarpal (CMC) amputations, but it is devoid of markings and body color. At this amputation level, it is very difficult to fit a functional prosthesis because of the short available length, unsightly shape, grafted skin, contracture and lack of functional prosthetic options. A 30-year-old male came to our clinic with amputation at the 1st to 4th carpometacarpal level and a 5th metacarpal that was projected laterally and fused with the carpal bone. The stump had grafted skin, redness, and an unhealed suture line. He complained of pain projected over the metacarpal and suture area. The clinical team members decided to fabricate a custom-made silicone hand prosthesis to accommodate the stump, protect the grafted skin, improve the hand's appearance and provide some passive function. The custom silicone hand prosthesis was fabricated with modified flexible wires to provide passive interphalangeal movement. Basic training, care and maintenance instructions for the prosthesis were given to the patient. The silicone hand prosthesis was able to restore the appearance of the lost digits and provide some passive function. His pain (VAS score) was reduced. Improvement in activities of daily living was found in the DASH questionnaire and Jebsen-Taylor Hand Function test. A silicone glove is a good option for more distal amputations, as it can accommodate any deformity, protect the skin, enhance the appearance and provide functional assistance. This case study provides a simple method to get passively movable fingers after proximal hand amputation.
到目前为止，美容手套是处理掌骨间（TMC）和腕掌关节（CMC）截肢最常用的方法，但它没有标记且与身体颜色不符。在这个截肢水平，由于可用长度短、形状难看、植皮、挛缩以及缺乏功能性假肢选择，很难安装功能性假肢。一名30岁男性来到我们诊所，其截肢部位在第1至第4掌骨水平，第5掌骨向外侧突出并与腕骨融合。残端有植皮、发红和未愈合的缝线。他抱怨掌骨和缝线区域有疼痛。临床团队成员决定制作一个定制的硅胶假手来适配残端，保护植皮，改善手部外观并提供一些被动功能。定制的硅胶假手采用改良的柔性电线制作，以提供指间被动活动。向患者提供了假肢的基本训练、护理和维护说明。硅胶假手能够恢复缺失手指的外观并提供一些被动功能。他的疼痛（视觉模拟评分）减轻了。在DASH问卷和Jebsen-Taylor手部功能测试中发现日常生活活动有所改善。硅胶手套对于更远端的截肢是一个不错的选择，因为它可以适应任何畸形，保护皮肤，改善外观并提供功能辅助。本案例研究提供了一种在近端手部截肢后获得可被动活动手指的简单方法。
