Peimer C A, Smith R J, Leffert R D
J Hand Surg Am. 1981 Mar;6(2):111-24. doi: 10.1016/s0363-5023(81)80164-5.
Nine patients seen in civilian practice with severe open injuries of the hand, including loss of portions of some or all of the metacarpals, were treated by primary restoration of metacarpal length and alignment by distraction-fixation with the use of transverse intermetacarpal Kirschner wires. An external fixation device was added in two of the nine patients. Severe associated soft tissue injuries were present in all but one patient. Two injuries were caused by firearms, and the other seven by heavy machinery. Contractures of the joints were prevented by the use of a second set of wires to position the metacarpophalangeal joints in 70 degrees of flexion and the first metacarpal in abduction and pronation. Staged closure of wounds by local or distant flaps and secondary reconstructions by bone, nerve, and tendon grafts or transfers were necessary in all and required an average of almost 2 years until treatment was completed. All except the one child and the one most recently injured patient have returned to employment or vocational retraining. Follow-up was 24 to 78 months from injury.
在普通门诊中，有9例手部严重开放性损伤患者接受了治疗，其中包括部分或全部掌骨缺失。治疗方法是使用横向掌间克氏针进行牵引固定，初步恢复掌骨长度和对线。9例患者中有2例加用了外固定装置。除1例患者外，其余患者均伴有严重的软组织损伤。2例损伤由火器所致，另外7例由重型机械造成。通过使用另一组克氏针将掌指关节置于70度屈曲位，第一掌骨置于外展和旋前位，预防关节挛缩。所有患者均需分期采用局部或远位皮瓣闭合伤口，并通过骨、神经和肌腱移植或转移进行二期重建，平均需要近2年才能完成治疗。除1名儿童和1名近期受伤的患者外，其他所有患者均已恢复工作或接受职业再培训。受伤后随访时间为24至78个月。
