重度掌腱膜挛缩症的显微外科治疗及临床康复

目的探讨重度掌腱膜挛缩症的治疗方法和效果。方法对9例（12侧）重度掌腱膜挛缩症患者，采用多“Z”形为主的切口，显微镜下锐性分离受累手指的神经血管柬，彻底切除病变组织，彻底止血后无张力下直接缝合或“V—Y”成形闭合，对皮肤缺损者采用全厚皮片植皮。术后第3天在医师指导下进行主被动伸屈功能锻炼．根据手指肿胀情况调整锻炼强度。切口愈合后应用背侧弹性支具加强伸屈功能锻炼，支具应用3个月以上。结果术后切口均愈合，植皮全部成活。平均随访10个月，依据TAM评定标准。优良率91．7％。结论采用显微手术技术切除病变组织结合术后康复锻炼是治疗重度掌腱膜挛缩症的有效方法。

Treatment for severe Dupuytren's contracture by microsurgical operation combined with rehabilitation exercise

Objective To investigate the clinical treatment and outcome of severe Dupuytren＇s contracture. Methods 9 cases （12 sides） of severe Dupuytren＇s contracture were treated by using zigzag incision, and separated sharply the neurovascular bundle from the involved fingers under microscope, resection the lesion tissue completely. The wound was coagulated thoroughly and sutured directly without tension or V-Y shape skin plasty. The secondary skin defect was covered by full-thickness skin graft. From the third day after operation, the patients began active and passive exercises with guidance. The intensity of extension and flexion was adjusted according to the finger＇s swelling. When the incision healed, a dorsal elastic splint was applied to strengthen the exercise for more than 3 months. Results None of the cases happened with skin necrosis or infection, and the grafted skin survived well. After a mean follow-up of 10 months, the excellent and good rate was 91.7%, according to TAM evaluation standard. Conclusion It is an effective method for treating severe Dupuytren＇s contracture that using microsurgical operation to resect the diseased tissue combined with rehabilitation exercise.