本文選題：掌腱膜攣縮癥 + 并發(fā)癥��； 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：目的 總結(jié)我院收治的掌腱膜攣縮癥患者的手術(shù)治療體會，探討手術(shù)并發(fā)癥、復(fù)發(fā)率與手術(shù)切口、掌腱膜切除范圍及攣縮程度的相關(guān)性；總結(jié)手術(shù)切口及切除范圍的優(yōu)缺點，分析手術(shù)并發(fā)癥的原因及復(fù)發(fā)的因素。 方法 對我院2007年10月～2014年8月收治的68例94只手掌腱膜攣縮癥患者的發(fā)病特點、手術(shù)方法、手術(shù)并發(fā)癥及遠(yuǎn)期療效進行回顧性分析。應(yīng)用統(tǒng)計學(xué)原理評價手術(shù)并發(fā)癥、復(fù)發(fā)率與手術(shù)切口、掌腱膜切除范圍、手指屈曲攣縮程度的相關(guān)性。 結(jié)果 本組病例68例94只手，其中男57例，女11例，男女之比：5.18:1。50歲～59歲患者最多，占50.00%，60歲以上患者占42.65%，可見掌腱膜攣縮癥好發(fā)于中老年男性。左側(cè)22例，右側(cè)20側(cè)，雙側(cè)26例；受累手指：共130指，其中示指6指，中指13指，環(huán)指59指，小指52指；環(huán)小指共111指，占所有受累手指的85.38%，最為多見。Tubiana分期： N期：17只手； a期：9只手； b期：12只手；ē期：21只手；ē期：18只手；期：17只手。手術(shù)早期并發(fā)癥的發(fā)生率為14.89%（14/94）。本組病例早期復(fù)合并發(fā)癥患者10例12只手，復(fù)合并發(fā)癥發(fā)生率為12.77%（12/94）。其中皮膚壞死的發(fā)生率為10.64%（10/94），皮膚感染的發(fā)生率為6.38%（6/94），皮下血腫的發(fā)生率為7.45%(7/94)，血管損傷的發(fā)生率為2.13%(2/94)，神經(jīng)損傷的發(fā)生率為3.19%(3/94)。通過統(tǒng)計學(xué)方法(SPSS21.0軟件)得出：皮下血腫、皮膚壞死與掌腱膜切除的范圍有關(guān)（P=0.042，P=0.041），皮膚壞死與手術(shù)切口的選擇有關(guān)（P=0.045），皮膚壞死與手指屈曲攣縮程度有關(guān)（P=0.035）；掌腱膜攣縮癥的復(fù)發(fā)與掌腱膜切除的范圍有關(guān)（P=0.033）。隨訪時間10～64個月，平均26個月。獲得隨訪患者59例80只手，復(fù)發(fā)5例6只手,復(fù)發(fā)率為7.50%。依據(jù)Adam評定法對掌腱膜攣縮癥術(shù)后效果進行評定：優(yōu)良率92.50%。 結(jié)論 掌腱膜攣縮癥好發(fā)于中老年男性，環(huán)小指最常受累。皮膚壞死與掌腱膜切除的范圍即剝離面積、手指攣縮屈曲畸形的程度、手術(shù)切口的選擇等因素有關(guān)；皮下血腫與掌腱膜切除的范圍即剝離面積有關(guān)，與手術(shù)切口、手指攣縮屈曲畸形的程度無關(guān)；復(fù)發(fā)與掌腱膜切除的范圍有關(guān)。掌腱膜攣縮癥復(fù)發(fā)的主要原因是病變組織切除不徹底，徹底切除病變組織是避免復(fù)發(fā)的關(guān)鍵。早期手術(shù)、精細(xì)操作，這將極大降低掌腱膜攣縮癥手術(shù)并發(fā)癥的發(fā)生率和復(fù)發(fā)率。
[Abstract]:Purpose To summarize the experience of surgical treatment in patients with palmar aponeurosis contracture in our hospital, to discuss the correlation between operative complications, recurrence rate and surgical incision, the extent of palmar aponeurosis resection and the degree of contracture, and to summarize the advantages and disadvantages of surgical incision and resection range. The causes and recurrence factors of surgical complications were analyzed. Method From October 2007 to August 2014, 68 cases (94 cases) with palmar aponeurosis contracture were retrospectively analyzed. The correlation between operative complications, recurrence rate and surgical incision, resection range of palmar aponeurosis and degree of flexion contracture of finger was evaluated by statistical principle. Result There were 94 hands in 68 cases, including 57 males and 11 females. The ratio of male to female was 5.18 to 1.50 years old and 59 years old, accounting for 42.65% of the patients over 50.000.60 years old. It can be seen that palmar aponeurosis is more common in middle and old men. The involved fingers were 130 fingers, including 6 fingers, 13 middle fingers, 59 ring fingers, 52 little fingers, 111 ring fingers, 20 left, 20 right and 26 bilateral fingers, respectively, and the affected fingers included 130 fingers, including 6 fingers, 13 middle fingers, 59 ring fingers, 52 little fingers, and 111 small fingers. Most of the 85.38 fingers involved were divided into N: 17 hands, a to 9 hands, b to 12 hands, 1 to 21 hands, 18 to 15 hands and 17 to 17 hands. The incidence of early complications was 14.89% of 94%. There were 12 hands in 10 patients with early complications, and the incidence of complex complications was 12.77% 12 / 94%. Among them, the incidence of skin necrosis was 10.64 / 94, the incidence of skin infection was 6.38 / 94, the incidence of subcutaneous hematoma was 7.4545 / 94 / 94, the incidence of vascular injury was 2.13 / 94, and the incidence of nerve injury was 3.19 / 94 / 94. The subcutaneous hematoma was obtained by SPSS 21.0 software. Skin necrosis is related to the extent of palmar aponeurosis resection, skin necrosis is related to the choice of surgical incision, skin necrosis is related to the degree of finger flexion contracture, and the recurrence of palmar aponeurotic contracture is related to the range of resection of palmar aponeurosis. The follow-up time was 10 ~ 64 months (mean 26 months). The recurrence rate was 7.50% in 59 cases (80 hands) and 5 cases (6 hands). The postoperative effect of palmar aponeurosis contracture was evaluated by Adam method: the excellent and good rate was 92.50%. Conclusion Metacarpal aponeurosis is more common in middle-aged men, ring the small finger is most often involved. Skin necrosis is related to the exfoliation area of metacarpal aponeurosis, the degree of deformity of finger contracture, the choice of surgical incision, and so on, the subcutaneous hematoma is related to the area of excision of palmar aponeurosis, which is related to the operative incision. The degree of flexion deformity of finger contracture was not related to the extent of resection of palmar aponeurosis. The main reason for recurrence of palmar aponeurosis contracture is the incomplete resection of the lesion tissue, which is the key to avoid recurrence. Early operation and fine operation will greatly reduce the incidence and recurrence of surgical complications of palmar aponeurosis contracture.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 黃一雄,侯明鐘,賈萬新,黃燮青,滕可穎,沈尊理;國人掌腱膜攣縮癥69例療效分析[J];實用手外科雜志;2002年01期

2 薛旦;黃宗堅;;“Z”字成形術(shù)與游離植皮術(shù)治療掌腱膜攣縮癥的比較[J];中國骨傷;2007年02期

3 熊革,栗鵬程,薛云皓,諸寅,張友樂,常萬紳,尹大慶;掌腱膜橈側(cè)攣縮的臨床特點與治療[J];中華手外科雜志;2004年04期

4 熊革,栗鵬程,朱瑾,諸寅,張友樂,常萬紳,韋加寧;小兒掌腱膜攣縮癥[J];中華小兒外科雜志;2004年05期

，

本文編號：1952114