Rodica Matei Ileana, Irina Ciura-Capota, Octavian Olariu, Georgescu Alexandru
Plastic Surgery Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj Napoca, Cluj, Romania.
Plastic Surgery Department, Spitalul Clinic de Recuperare, Cluj Napoca, Cluj, Romania.
J Hand Surg Glob Online. 2024 Jul 12;7(2):259-265. doi: 10.1016/j.jhsg.2024.02.016. eCollection 2025 Mar.
This study will present our experience in treating "spaghetti wrist," a complex injury of the distal forearm, with laceration of tendons, nerve(s), artery(es), and soft tissues. Also, we will present a review of the literature summarizing preoperative preparations, surgical and rehabilitation therapy, and immediate and delayed postoperative outcomes. The patients had complex injuries located in the distal 1/3 of the forearm, regardless of the physical etiologic agent, encompassing breach of the deep antebrachial fascia, at least one nerve, tendons, and, in some cases, arteries, along with single or multiple skin lacerations. The surgical procedure included surgical debridement, fasciotomy, decompression incisions, neurorrhaphy, tenorrhaphy, arteriorrhaphy, and soft tissue coverage protected by active/passive drainage. Depending on the anatomical structures reconstructed, the rehabilitation protocol was personalized, initially with dorsal immobilization in a plaster cast, followed by, as early as possible, passive and then active mobilization, under a single hand therapist's control. Following prompt surgical intervention and adjusted personalized rehabilitation protocol, the results of even this type of challenging cases can be successful. The earlier the rehabilitation protocol was initiated, the better the results were. Patient adherence to the complex algorithm of treatment was also one of the most important prognostic aspects. What happens after the healing is another important aspect because the most devastating chronic complications, nervous deficits, must be evaluated and treated using modern possibilities.
本研究将介绍我们治疗“意大利面条腕”（一种前臂远端的复杂损伤，伴有肌腱、神经、血管和软组织撕裂伤）的经验。此外，我们还将对文献进行综述，总结术前准备、手术及康复治疗，以及术后即刻和延迟的结果。患者前臂远端1/3处有复杂损伤，无论物理病因如何，包括前臂深筋膜破裂、至少一条神经、肌腱，部分病例还有血管损伤，以及单处或多处皮肤撕裂伤。手术操作包括手术清创、筋膜切开减压、减压切口、神经缝合、肌腱缝合、血管缝合，以及通过主动/被动引流保护的软组织覆盖。根据重建的解剖结构，康复方案个性化定制，最初用石膏固定于背侧，随后尽早在单手治疗师的指导下进行被动和主动活动。经过及时的手术干预和调整后的个性化康复方案，即使是这类具有挑战性的病例也能取得成功。康复方案启动得越早，效果越好。患者对复杂治疗方案的依从性也是最重要的预后因素之一。愈合后的情况是另一个重要方面，因为最严重的慢性并发症——神经功能缺损，必须利用现代手段进行评估和治疗。
