[1]张睿,王飞燕,刘生和,等.严重意面腕损伤的诊治及疗效分析[J].中华老年骨科与康复电子杂志,2023,(01):3-10.[doi:10.3877/cma.j.issn.2096-0263.2023.01.002]
　Zhang Rui,Wang Feiyan,Liu Shenghe,et al.Management and outcome assessment for severe spaghetti wrist injury[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2023,(01):3-10.[doi:10.3877/cma.j.issn.2096-0263.2023.01.002]
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严重意面腕损伤的诊治及疗效分析()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2023年01期
页码:
3-10
栏目:
上肢
出版日期:
2023-02-05

文章信息/Info

Title:
Management and outcome assessment for severe spaghetti wrist injury
作者:
张睿; 王飞燕; 刘生和; 李善语; 徐佳; 康庆林
200233 上海交通大学医学院附属第六人民医院骨科
Author(s):
Zhang Rui;  Wang Feiyan;  Liu Shenghe;  Li Shanyu;  Xu Jia;  Kang Qinglin.
Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
关键词:
复杂前臂创伤;  意面腕损伤;  多种组织损伤;  诊治;  疗效
Keywords:
Complex forearm trauma;  Spaghetti wrist injury;  Multiple tissue injury;  Management;  Outcomes
DOI:
10.3877/cma.j.issn.2096-0263.2023.01.002
文献标志码:
A
摘要:
目的 回顾我科收治的严重意面腕损伤急诊修复手术的开展情况及临床疗效，总结此类损伤的临床特征和诊治要点。方法 本研究回顾2020年1月1日至2021年12月31日于我院急诊骨科治疗的意面腕损伤患者27例，按受伤场所将患者分为工伤组13例和生活组14例，其中男性24例，女性3例，年龄15至70岁，平均年龄（45±14）岁，其中左侧14例，右侧13例。损伤结构均予一期修复，术后随访观察患肢功能及并发症，并比较两组患者损伤结构数量、损伤机制、Noaman功能评价和DASH评分。结果 工伤组掌侧肌腱损伤（9.1±2.9）条，背侧肌腱损伤（2.2±0.5）条，17例动脉断裂，23例神经断裂，9例骨折，平均随访（17.8±5.8）月，1例出现局部感染，Noaman评价各分项优良率达61.5%以上，DASH评分（17.2±4.7）分。生活组掌侧肌腱损伤（9.1±2.3）条，背侧肌腱损伤（1.9±0.6）条，20例动脉断裂，25例神经，未及骨折，平均随访（16.0±4.9）月，未及严重并发症，Noaman评价各分项优良率达57.1%以上，DASH评分（13.9±6.9）分。两组仅在损伤方位（c2=23.280，P＜0.05）、损伤机制（c2=27.000，P＜0.05）和固定方式（c2=6.608，P＜0.05）上差异存在统计学意义，在肌腱、血管、神经损伤数量、Noaman评价各分项及DASH评分等方面差异均无统计学意义，但生活组仍呈现出桡侧较尺侧更易损伤的趋势。 结论 伴有主要神经和血管断裂的意面腕损伤可存在多处屈、伸肌腱断裂，损伤方位与损伤发生的场所有关，修复策略也应据此进行灵活调整。尽管经过及时修复与系统康复后的患肢功能明显改善，严重意面腕损伤的诊治仍是骨科医生面临的严峻挑战。高效的团队配合、娴熟的修复技巧和系统的康复训练能够保存功能、改善预后。
Abstract:
Objective To review the implementation and outcomes of emergency repair and reconstruction surgery of spaghetti wrist injury and to summarize characteristics and key points of this injury and its management. Methods This research reviewed 27 cases (24 males and 3 females) of severe spaghetti wrist injury who received emergency repair and reconstruction surgery between January, 2020 and December, 2021, at our hospital. Patients were divided into working accident group (13 cases) and living-related group (14 cases) according to the place of injury, aging from 15 to 70 years old (45±14 y). Outcomes and complications were followed postoperatively. Numbers of lacerated structures, mechanisms of injury, Noaman’s outcome evaluation system and DASH score were compared. Results In the working accident group, (9.1±2.9) ventral tendons and (2.2±0.5) dorsal tendons were lacerated on average, with 17 arteries and 23 nerves transected in total. Nine cases of fractures were also observed. This group was followed (17.8±5.8) months and one temporary infection was observed and cured. A rate of at least 61.5% in each aspect of Noaman’s outcome evaluation system was received with an average of (17.2±4.7) in DASH score. In the living-related group, (9.1±2.3) ventral tendons and (1.9±0.6) dorsal tendons were lacerated on average, with 20 arteries and 25 nerves transected in total. No fracture was observed. This group was followed (16.0±4.9) months and one temporary infection was observed and cured. A rate of at least 57.1% in each aspect of Noaman’s outcome evaluation system was received with an average of (13.9±6.9) in DASH score. There were significant differences in the aspects of side of injury (c2=23.280, P<0.05), mechanism of injury (c2=27.000, P<0.05) and type of fixation (c=6.608, P<0.05). However, there was no significant difference in the aspects of numbers of injured tendons, nerves and vessels, Noaman’s outcome evaluation system or DASH score. Besides, the living-related group showed a tendency of more vulnerable radial structures. Conclusions Multiple flexor and extensor tendon injuries were observed if the injury was composed of simultaneous laceration of main nerve and vessel of the wrist. Injury side can be related to injury site, according to which the surgeon shall adjust reconstruction strategies. Although limb functionality was partially improved after in time repair and systematic rehabilitation, severe spaghetti wrist injury still remains challenging for orthopedists. Effective teamwork, great skills in repair surgery and systematic rehabilitation would rescue the motor and sensory function of the injured limb and improve the prognosis.

备注/Memo

备注/Memo:
基金项目：国家自然科学基金（82072421），上海市自然科学基金（20ZR1442200）
更新日期/Last Update: 2023-03-30