掌腱膜部分切除术治疗掌腱膜挛缩症

目的 探讨掌腹腱膜挛缩症治疗的临床经验。方法 1980年以来，我院共治疗掌腱膜挛缩症22例，全部采用掌腱膜部分切除术。结果 19例病人获得满意的治疗效果，应用Tubiana’s法评价，手术后优良率为86．4％，效果良好。结论 本手术成功的关键在于：仔细分离皮瓣，避免皮肤坏死；避免血管神经束损伤；彻底切除挛缩腹膜，避免术后复发；彻底止血，防止血肿形成和感染；术后早期进行功能锻炼。     

掌腱膜挛缩症的手术治疗

掌腱膜挛缩症是指掌筋膜及手指筋膜广泛的纤维变性 ,以皮下结节和纤维束带为特征 ;导致手指继发性屈曲挛缩畸形 ,并伴皮下脂肪变薄 ,皮肤与病变处粘连凹陷为特征的疾病[1] 。1993年以来 ,我院共收治 17例 ,均采用手术治疗 ,获得了满意的效果。一、资料与方法1.一般资料 :本组共 17例 18指 ,男 16例 ,女 1例 ;年龄43～ 65岁 ,平均 5 3岁。右手 12例 ,左手 5例。病变分型 :(1)轻度 :手指掌指关节、近侧指间关节、远侧指间关节屈曲挛缩度数的总和 <45° ;本组共 9指。 (2 )中度 :手指ＤＰ、ＰＩＰ、ＤＩＰ屈曲挛缩度数的总和为 45°～ 90° ;本…     

掌腱膜挛缩症的治疗进展

掌腱膜挛缩症（Dupuytren'sDisease）流行于北欧及其他欧美地区，是以掌腱膜增生、收缩引起手指屈曲挛缩为特征的一种病症。早在1833年GuillaumeDupuytren在巴黎就作过一个专题报告。170多年来对于该病的发病原因的探究一直是医学界关心的热门课题。近年来，杂志上有不少专题报告介绍利用分子生物学、细胞生物学遗传学技术进行掌腱膜挛缩症的基础研究，并取得了一定的进展。HandClinics在1999年还出一期专刊，特此综述供同道们参考。１掌筋膜综合体的解剖与病理１．１解剖学研究Rayan用手术显微镜和小型关节镜对10具尸体手的掌腱膜作详尽…     

掌腱膜挛缩症的手术治疗

1997年10月-2005年7月，我科对11例（17指）掌腱膜挛缩症的患者进行了手术治疗，效果满意。     

掌腱膜挛缩症的诊断与治疗

掌腱膜挛缩是一种进行性增殖组织纤维变性病,好发于老年人,主要以掌腱膜增厚,收缩,手指屈曲挛缩为特征的手部畸形,多伴有手掌皮下脂肪变薄,皮肤凹陷并与掌腱膜粘连。本病以欧美国家多见,国内发病率较低,但近年发病率呈上升趋势,可能与社会人口中老年人比例增加,生活条件改善等原因有关[1-3]。1资料与方法本组13例,年龄30～73岁,男女之比为10:3,病程1个月～2年,其中12人为体力劳动者,1人为非体力劳动者。患病手指:中指2指,环指10指,小指8指。双侧3例,单侧10例,其中左侧者4例,右侧者6例。根据黄硕麟分型标准:Ⅱ型1例,Ⅲ3例,Ⅳ9例。有明确家族…     

手术显微镜下切除掌腱膜治疗掌腱膜挛缩症的方法及体会

１８２３年法国Ｄｕｐｕｙｔｒｅｎ报告掌腱膜挛缩症是由于掌腱膜挛缩而引起的手部继发性畸形。我院自１９８０年以来，在手术显微镜下切除掌腱膜治疗掌腱膜挛缩症２１例，收到良好的效果。１临床资料本组男１８例，女３例，年龄１９～７４岁，平均５３岁。工人１７例，干...     

掌腱膜挛缩症的流行病学

掌腱膜挛缩症又称Dupuytren氏挛缩或Dupuytren氏病,是以进行性掌腱膜纤维组织短缩、增厚为特征,进而逐渐发生手指及关节屈曲畸形的一种病症,严重影响中老年人手部功能,且有报道该病患者癌症死亡率也较高[1].早在17世纪,已有该病的外科记录.1831年,法国医师BG Dupuytren较为详细的描述了该病的解剖及临床特点,与现今对该病的认识较为接近,故西方称为Dupuytren's disease(DD).该病的发病机制至今仍未清楚,现就其流行情况及发病的相关因素作一综述.     

国人掌腱膜挛缩症的诱因及显微外科治疗

１９７９年１月～１９９７年１２月,本院治疗掌腱膜挛缩症（Ｄｕｐｕｙｔｒｅｎｓｃｏｎｔｒａｃｔｕｒｅ,简称ＤＣ）４２例,全部汉族。男３６例,女６例,男女之比６１。年龄３３岁～７８岁,平均６２．６岁。５０岁前６例,５１岁～６０岁１０例,６１岁～７０岁１５...     

17例掌腱膜挛缩症的疗效分析

我科自1990年12月～2003年4月共收治17例掌腱膜挛缩症患者,行手术治疗后,随访3个月～2年,现对各期手术的疗效分析报道如下。1资料与方法1.1一般资料17例掌腱膜挛缩症患者,男15人,女2人,男女比例为7.5:1;年龄在45岁～73岁,平均为63岁。其中单手发病15例,双手同时发病2例。双手同     

Dupuytren's contracture: an update of biomolecular aspects and therapeutic perspectives

The so-called fibrogenic cytokines, able to induce the growth of fibroblasts and their differentiation into myofibroblasts and to stimulate their production of extracellular matrix, are involved in the genesis of Dupuytren's contracture. Although many studies have been made of biomolecular aspects of palmar fibromatosis, practical applications from them are still far from imminent because of the real difficulty of blocking their action in vivo, even in a chronic, progressive lesion such as Dupuytren's disease. Consequently, surgical excision of the palmar fascia still remains the treatment of choice.     

Bloodflow in the Finger in Dupuytren's contracture

Summary 1. There is a high incidence of latent vasospastic changes in the hands of patients with DC regardless of the state of the disease. 2. The high incidence of vasospasm and ulnar nerve lesions in DC suggest, that in some ways these are related to the pathogenesis. 3. Comparing patients with a normal finger plethysmogram with those with a vasospastic vessel-reaction, there is no correlation concerning the ulnar nerve lesions in DC. Therefore we assume that these are independent constitutional factors. — 4. The disturbance in blood flow in the hand in DC is usually asymptomatic and is probably a different phenomenon from that seen in Raynaud's Syndrome.Partly read at the International Hand Surgery Congress, Melbourne, Australia, November 14, 1979     

Immunohistochemical evidence of nerve growth factor in Dupuytren's diseased palmar fascia

PURPOSE: Histologically, the pathognomic feature of Dupuytren's contracture (DC) is the myofibroblast. Its occurrence in this disease has been associated with local production of transforming growth factor (TGF)-B. However, nerve growth factor (NGF) is a recognized growth factor involved in wound healing and has been shown to induce the myofibroblast phenotype in cultured fibroblasts. We hypothesized that NGF would be abundant in this disease entity. METHODS: Immunohistochemistry was used to examine for the presence of NGF in 25 surgical specimens from patients with DC and in surgical specimens from 5 other, unrelated procedures. Patient demographics showed that nearly all patients were men, with a mean age of 61 years (range 36-77). Serial sections were probed with antibodies, stained, and then digitally photomicrographed. Disease staging was also performed. Image analysis was then used to measure the percentage of area stained. In addition, representative sections were probed for TrkA, the high-affinity receptor for NGF, and alpha-smooth muscle actin, a cytoskeletal marker of the myofibroblast phenotype. These alternate steps were used to infer functional dependence and the association of NGF with myofibroblast populations. RESULTS: Histologically, all patients had either stage II or III disease. Biopsy results showed an abundance of NGF--over double that of controls. The highest levels of NGF occurred in hypercellular stage II disease. In addition, we confirmed that NGF is linked to the expression of both TrkA receptors and alpha-smooth muscle actin. CONCLUSIONS: Tissue levels of NGF are elevated in Dupuytren's disease. This tissue is competent to respond to NGF and manifests an abundance of myofibroblasts in areas of NGF expression. Nerve growth factor is most apparent in the proliferative (hyperplastic) stage of the disease. These data infer that NGF is linked to the pathologic process.     

Dupuytren's disease of the big toe

This short paper present four cases of Dupuytren's disease of the big toe.     

掌腱膜挛缩症的手术治疗

目的 探讨掌腱膜挛缩症手术方法的改进,分析其疗效.方法 2008年9月至2009年8月,采用掌腱膜部分切除术治疗掌腱膜挛缩症患者9例11侧,对传统的治疗方法加以改进,以游离植皮的理念处理掌侧皮瓣.结果 本组患者术后切口均Ⅰ期愈合,无皮下血肿、皮缘坏死、切口感染等术后早期并发症发生.随访1～6个月,平均3.3个月,无一例复发.按中华医学会手外科学会上肢部分功能评定试用标准评定:患手运动功能优9例,良2例;优良率为100%.结论 在掌腱膜部分切除术中以游离植皮的理念处理掌侧皮肤可明显降低术后早期并发症.