掌腱膜挛缩症的临床回顾性研究

发布时间：2018-05-29 19:31

本文选题：掌腱膜挛缩症 + 并发症　；参考：《吉林大学》2015年硕士论文

【摘要】：目的总结我院收治的掌腱膜挛缩症患者的手术治疗体会，探讨手术并发症、复发率与手术切口、掌腱膜切除范围及挛缩程度的相关性；总结手术切口及切除范围的优缺点，分析手术并发症的原因及复发的因素。方法对我院2007年10月～2014年8月收治的68例94只手掌腱膜挛缩症患者的发病特点、手术方法、手术并发症及远期疗效进行回顾性分析。应用统计学原理评价手术并发症、复发率与手术切口、掌腱膜切除范围、手指屈曲挛缩程度的相关性。结果本组病例68例94只手，其中男57例，女11例，男女之比：5.18:1。50岁～59岁患者最多，占50.00%，60岁以上患者占42.65%，可见掌腱膜挛缩症好发于中老年男性。左侧22例，右侧20侧，双侧26例；受累手指：共130指，其中示指6指，中指13指，环指59指，小指52指；环小指共111指，占所有受累手指的85.38%，最为多见。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。手术早期并发症的发生率为14.89%（14/94）。本组病例早期复合并发症患者10例12只手，复合并发症发生率为12.77%（12/94）。其中皮肤坏死的发生率为10.64%（10/94），皮肤感染的发生率为6.38%（6/94），皮下血肿的发生率为7.45%(7/94)，血管损伤的发生率为2.13%(2/94)，神经损伤的发生率为3.19%(3/94)。通过统计学方法(SPSS21.0软件)得出：皮下血肿、皮肤坏死与掌腱膜切除的范围有关（P=0.042，P=0.041），皮肤坏死与手术切口的选择有关（P=0.045），皮肤坏死与手指屈曲挛缩程度有关（P=0.035）；掌腱膜挛缩症的复发与掌腱膜切除的范围有关（P=0.033）。随访时间10～64个月，平均26个月。获得随访患者59例80只手，复发5例6只手,复发率为7.50%。依据Adam评定法对掌腱膜挛缩症术后效果进行评定：优良率92.50%。结论掌腱膜挛缩症好发于中老年男性，环小指最常受累。皮肤坏死与掌腱膜切除的范围即剥离面积、手指挛缩屈曲畸形的程度、手术切口的选择等因素有关；皮下血肿与掌腱膜切除的范围即剥离面积有关，与手术切口、手指挛缩屈曲畸形的程度无关；复发与掌腱膜切除的范围有关。掌腱膜挛缩症复发的主要原因是病变组织切除不彻底，彻底切除病变组织是避免复发的关键。早期手术、精细操作，这将极大降低掌腱膜挛缩症手术并发症的发生率和复发率。
[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.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.2

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