Han Rongcan, Li Chengli, Guo Xinfeng, Yuan Ye, Deng Jiuzheng, Pan Yongwei
School of Clinical Medicine, Tsinghua University, Beijing, 100084, P.R.China.
Department of Orthopedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Apr 15;35(4):483-487. doi: 10.7507/1002-1892.202011004.
To investigate the effectiveness of retrograde muscle release in treatment of mild to moderate type ischemic muscle contracture of forearm classified by Tsuge.
Between March 2010 and September 2018, 11 patients with mild to moderate ischemic muscle contracture of forearm were treated with retrograde muscle release. There were 6 males and 5 females with an average age of 24 years (range, 16-29 years). According to Tsuge classification, 6 cases were mild type and 5 cases were moderate type. The interval between injury and operation was 9 months to 25 years, with a median of 17 years. The scar cords in the muscle of the middle one-third of the forearm was released firstly. If the standard of sufficient release was not reached, further releasing the scar cords in the muscle and the tense tendon structure in the proximal one-third of the forearm and the origins of the flexor muscles was necessary. If the standard was still not reached, the origins of the flexor muscles can be released and slid. The effectiveness was evaluated from six aspects of the range of motion of the hand and wrist, dexterity, grip strength, sensation, subjective function scores [quick-disability of the arm, shoulder, and hand questionnaire (Quick-DASH) and the patient-related wrist/hand evaluation (PRWHE)] and satisfaction.
All the incisions healed by first intention. Eight patients were followed up 1-106 months (median, 13 months). The range of motion of the hand and wrist was significantly improved, the results were excellent in 3 cases, good in 3 cases, and fair in 2 cases, with an excellent and good rate of 75%. The patient's dexterity evaluation scored a perfect score of 12, which was close to the normal hand dexterity. At last follow-up, the grip strength on the affected side was 37.6%-95.5% of the contralateral side, with an average of 77.6%. Seven patients had normal sensation before and after operation, and the two-point discrimination of median nerve and ulnar nerve was 4-5 mm at last follow-up; 1 patient with forearm mechanical crush injury still felt numb after operation, and the two-point discrimination of median nerve and ulnar nerve was 8 mm and 7 mm, respectively. The Quick-DASH score was 0-15.9, with an average of 4.5, and the PRWHE score was 0-23.0, with an average of 6.6. All the patients were satisfied with the surgery and the effectiveness.
A targeted retrograde muscle release method for mild to moderate type ischemic contracture of forearm can achieve satisfactory effectiveness.
探讨逆行肌肉松解术治疗津下分类的轻至中度前臂缺血性肌挛缩的疗效。
2010年3月至2018年9月，对11例轻至中度前臂缺血性肌挛缩患者行逆行肌肉松解术。其中男6例，女5例，平均年龄24岁（16～29岁）。按津下分类，轻度6例，中度5例。受伤至手术间隔时间为9个月至25年，中位数为17年。先松解前臂中1/3肌肉内的瘢痕条索，若未达到充分松解标准，则需进一步松解前臂近1/3肌肉内的瘢痕条索及紧张的肌腱结构和屈肌起点。若仍未达到标准，则可松解并滑移屈肌起点。从手腕活动范围、灵巧性、握力、感觉、主观功能评分[手臂、肩部和手部快速残疾问卷（Quick-DASH）及患者相关的手腕/手部评估（PRWHE）]和满意度6个方面评估疗效。
所有切口均一期愈合。8例患者获随访，时间1～106个月（中位数13个月）。手腕活动范围明显改善，优3例，良3例，可2例，优良率75%。患者灵巧性评估得满分12分，接近正常手灵巧性。末次随访时，患侧握力为对侧的37.6%～95.5%，平均为77.6%。7例患者手术前后感觉正常，末次随访时正中神经和尺神经两点辨别觉为4～5mm；1例前臂机械挤压伤患者术后仍感麻木，正中神经和尺神经两点辨别觉分别为8mm和7mm。Quick-DASH评分为0～15.9分，平均4.5分；PRWHE评分为0～23.0分，平均6.6分。所有患者对手术及疗效均满意。
针对轻至中度前臂缺血性挛缩的逆行肌肉松解术可取得满意疗效。
