Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 200233 Shanghai, China.
Jt Dis Relat Surg. 2022;33(2):273-284. doi: 10.52312/jdrs.2022.652. Epub 2022 Jul 6.
This study aims to point out the key principles for the management of multicomponent soft tissue injuries of the wrist and forearm to discuss whether we should expand the term "spaghetti" from the wrist to forearm in such terrifying cases.
Data from a total of 50 patients (44 males, 6 females; mean age: 48.5±25.7 years; range, 10 to 70 years) who were treated for multicomponent soft tissue injuries of the wrist and forearm, including at least one major artery and one major nerve, between February 2020 and December 2021 were retrospectively analyzed. The patients were divided into the wrist injury group (n=30) and forearm injury group (n=20) according to the location of laceration. Demographic characteristics, including age, sex ratio and mechanism and side of injury, total lacerated structures, and outcomes, including tendon function, opposition, intrinsic muscle function, deformities, sensation and grip strength were evaluated.
In the wrist injury group, a mean of 12.27±3.53 structures at the volar side were injured. It took a mean time of 1.8±0.4 h for emergency surgical repair and, after a mean of 16.6±5.3 month follow-up, most patients received excellent/good outcomes in the six aspects. In the forearm injury group, a mean of 12.95±2.96 structures at the volar side were injured. It took an average time of 2.1±0.4 h for emergency surgical repair and, after a mean of 15.4±6.4 month follow-up, most patients received excellent/good outcomes and were satisfied with the functional recovery. Only surgical time (p=0.018) and final grip strength (p=0.023) between the two groups showed a statistically significant difference.
We propose to merge the severe wrist and proximal forearm laceration of multiple tendons/muscles with at least one major artery and one major nerve as a whole, namely the spaghetti-ketchup injury, since the laceration of wrist and that of proximal forearm in this study share similar mechanisms and outcomes after primary repair or reconstruction.
本研究旨在指出腕部和前臂多部位软组织损伤的处理关键原则，并探讨在这种严重情况下是否应将“意大利面条”一词从腕部扩展到手前臂。
回顾性分析 2020 年 2 月至 2021 年 12 月期间收治的 50 例（男 44 例，女 6 例；平均年龄：48.5±25.7 岁；范围：10-70 岁）腕部和前臂多部位软组织损伤（至少一条主要动脉和一条主要神经损伤）患者的资料。根据损伤部位，将患者分为腕部损伤组（n=30）和前臂损伤组（n=20）。评估的人口统计学特征包括年龄、性别比例、损伤机制和侧别、总撕裂结构以及包括肌腱功能、对掌、内在肌肉功能、畸形、感觉和握力在内的结局。
腕部损伤组，掌侧平均损伤 12.27±3.53 个结构。急诊手术修复平均耗时 1.8±0.4 小时，平均随访 16.6±5.3 个月后，大多数患者在六个方面获得了优秀/良好的结局。前臂损伤组，掌侧平均损伤 12.95±2.96 个结构。急诊手术修复平均耗时 2.1±0.4 小时，平均随访 15.4±6.4 个月后，大多数患者对功能恢复感到满意，获得了优秀/良好的结局。仅手术时间（p=0.018）和最终握力（p=0.023）两组间存在统计学差异。
我们建议将至少一条主要动脉和一条主要神经合并的严重腕部和前臂近端多肌腱/肌肉撕裂伤作为一个整体来处理，即“意大利面条-番茄酱”损伤，因为本研究中腕部和前臂近端撕裂伤的机制和术后重建结果相似。
