【作者】 周浩；

【导师】 潘志军；

【作者基本信息】 浙江大学 ， 骨外科， 2007， 硕士

【摘要】 目的：研究各种手术治疗方法在掌腱膜挛缩症中的临床效果，探索掌腱膜挛缩症的最佳手术方法。方法：回顾性调查浙江大学医学院附属第二医院骨科1990年至2006年12月收治的35例掌腱膜挛缩症患者，这些患者分别采用了不同的手术治疗方案，通过查阅病历资料、电话随访、门诊复查等手段获取所需的信息。1．了解患者的年龄、性别、生活习惯、健康状况、病变部位、病变类型、手术方法、术后并发症、复发情况等。2．对获得的以上信息进行分类整理，分析患者在年龄、性别、健康状况、病变部位、病变类型等的分布情况，了解各种手术方法的复发率、术后并发症情况。3．比较各种手术方法的复发率、术后并发症情况，获得较为有效、满意的治疗方案。结果：35个病例中，其中男性32例，女性3例，男女之比约为10：1。本组共52只手。行掌腱膜部分切除术者14只手(黄氏Ⅲ型12只手，Ⅳ型2只手)复发6只手(Ⅲ型4只手，Ⅳ型2只手)复发率42.86％。行掌腱膜皮肤切除及皮肤移植术者38只手(Ⅲ型3只手，Ⅳ型35只手)复发0只手，但其他手指或另一手再发者5例。在所有患者中，具有高危因素的15例复发5例，复发率为33.3％；无高危因素者20例，复发1例，复发率为5％；两组之间具有统计学差异(P＜0.05)。复发患者均为掌腱膜部分切除术后者。结论：1．手术治疗掌腱膜挛缩症可以获得比较满意的疗效，掌腱膜部分切除术术后有部分病人复发，但其术后并发症相对较少。掌腱膜皮肤切除及皮肤移植术后目前还没有发现复发患者，但是术后并发症相对较多。2．对于一些具有复发高危因素的患者，如高血脂、酗酒、糖尿病等，掌腱膜皮肤切除及皮肤移植术能有效地防止复发。但是并不能防止再发。更多还原

【Abstract】 Objective: Investigate the clinic results of different surgical treatment methods of Dupuytren’s Contracture, to explore the best treatment.Method: With 35 cases accepting different surgical treatment were reviewed, these cases were treated in the Orthopedics Department of the Second Affiliated Hospital of Medical School Zhejiang University,Within Sep, 1990 to Dec, 2006. Data was collected from the medical records, telephone following-up and clinic rechecking.1.Collecting patient’s age, gender, habit, health information, place of contracture, type of pathology, operation method, complications and recurrence.2.Sorting data through classifying the cases by age、 gender、 health information、 place of contracture、 type of pathology、 operation method, then analyzing the recurrence rate and complication of different operations method.3. Comparing the recurrence rate and complication of different operation methods, find out which way is better.Result: Within 35 cases, male 32, female 3, the ratio of men to women is about 10:1. There are 52 hands, 14 hands were carried on by palmare fascia partial excision (4 Huang type III, 2 type IV),among them, 6 hands (4 type III,2 type IV)recurred, the rate was 42.86%. 38 hands were carried an by palmare fascia excision and skin transplantation(3 type III, 35 type IV),no hand recurred, but 5 cases relapsed in another fingers or the other hand. In all cases, 5 cases recurred among the 15 cases which have risk factors, as the rate 33.3%; 1 cases recurred among the 20 cases without risk factors recurred, as the rate 5%;There are significant difference between the two sets(P<0.05).All recurrence occurred in those suffered palmare fascia partial excision.Conclusion: 1.The surgical treatment of Dupuytren’s Contracture can acquire satisfied result and effect, there were some recurrence in palmare fascia partial excision group with less complication. Today, these is no recurrence report in palmare fascia excision and skin transplantation group, while there were more and severer complications in this group.2. For the cases who have risk factors, such as hyperlipmia, insobriety and diabetes, palmare fascia excision and skin transplantation can prevent from recurring effectively, but not relapsing in the other fingers or another hand.更多还原