頁籤選單縮合
題名 | Functional Assessment of Free Lateral Arm Flap for Posttraumatic First Web Contracture=以游離外側上臂皮瓣重建創傷後虎口攣縮之功能性評估 |
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作 者 | 姚全豐; 林有德; 林志鴻; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷期 | 23:3 2014.09[民103.09] |
頁次 | 頁197-206 |
分類號 | 416.615 |
關鍵詞 | 虎口攣縮; 游離外側上臂皮瓣; Lateral arm flap; First web contracture; Functional assessment; |
語文 | 英文(English) |
中文摘要 | 背景:外傷後的虎口攣縮對手部功能影響甚鉅,手術放鬆攣縮後選用適合的軟組織重建是治療的基石。目的及目標:在此研究中,我們以游離外側上臂皮瓣來重建虎口攣縮放鬆手術後的軟組織缺損,並對患者做術後的手功能評估。材料及方法:從1990年8月到2008年1月,21名嚴重虎口攣縮(術前掌骨間角度小於30度)的病患接受攣縮放鬆及游離外側上臂皮瓣重建手術,並以兩支交叉K-wire來維持對掌姿勢2週。我們測量掌骨間角度及Kapandji分數,此外我們也記錄了術後雙手的握力及捏力(包含key pinch、pulp pinch及tripod pinch)。我們採用電話會談的方式,以密歇根手功能問卷來評估患者對手部功能的主觀感受。結果:手術後掌骨間角度平均增加34度(p<0.001),Kapandji分數的中位值從術前的3增加為術後的6。至於術後手部的握力及捏力,健側手都優於患側手:平均握力(健側78.2磅、患側34.2磅,p<0.01);平均捏力key pinch(健側19.3磅、患側8.7磅,p<0.01),pulp pinch(健側14.6磅、患側7.1磅, p<0.01),tripod pinch(健側16.8磅、患側7.8磅,p<0.05)。在密歇根手功能問卷中,整體手功能、日常生活、工作、外觀及病患滿意度這幾項的分數都有顯著的進步。結論:使用游離外側上臂皮瓣做為嚴重虎口攣縮的重建有效的增加虎口張開的弧度及對掌功能。由於外傷造成的傷害常牽涉虎口以外的組織,患側手即使在接受手術後力量仍不如健側。 |
英文摘要 | Background: Posttraumatic first web contracture has a significant negative effect on the hand function. Surgical release of the contracture followed by adequate soft tissue coverage is the cornerstone of treatment. Aim and Objectives: Retrospectively, we review our experience of using free lateral arm flap for soft tissue reconstruction after surgical release of posttraumatic severe first web contracture. Functional outcome evaluation was performed in this series. Materials and Methods: During August 1990 and January 2008, 21 patients with severe first web contracture (preoperative intermetacarpal angle less than 30 degrees) received surgical release with free lateral arm flap interpositioning reconstruction, followed by cross K-wires to keep the web space in abduction and circumduction for 2 weeks. Intermetacarpal angle and Kapandji score were measured. We also recorded the power of grip, key pinch, pulp pinch and tripod pinch in both hands by dynamometers during the postoperative follow-up. A hand-specific outcome questionnaire-Michigan Hand Outcome Questionnaire (MHQ) Chinese version was administered by telephone interview. Results: The average increase in intermetacarpal angle is 34 degree (p<0.001). The Kapandji score improves from the preoperative median 3 to postoperative median 6. As for the power measurement postoperatively, the uninjured side showed better results: average grip power (78.2 pounds VS 34.2 pounds, p<0.01); key pinch (19.3 pounds VS 8.7 pounds, p<0.01), pulp pinch (14.6 pounds VS 7.1 pounds, p<0.01), tripod pinch (16.8 pounds VS 7.8 pounds, p<0.05). The overall hand function, activities of daily living, work, aesthetics and satisfaction score of MHQ improved significantly. Conclusion: The use of free lateral arm flap for severe posttraumatic first web contracture effectively improves the opposition function and span of grasp. Due to the pre-existing injuries, the grip power of the injured hand is inferior to the uninjured side. |
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