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find Keyword "拇指" 66 results
  • 在护理本科生操作实习中开展拇指教育的探索

    目的:对在护理本科生的操作实习中开展拇指教育的探索。方法:在护理本科生开展关于拇指教育的调查,对调查结果进行分析。结果:护理本科生普遍认为拇指教育更有利于自我的成长。结论:在临床带习老师中定期开展拇指教育的学习非常有必要。

    Release date:2016-08-26 02:21 Export PDF Favorites Scan
  • REPAIR OF SEVERE NAIL BED DEFECTS WITH RADIAL DORSAL FASCIOCUTANEOUS FLAP OF THUMB

    Objective To summarize the effectiveness of radial dorsal fasciocutaneous flap of thumb for repairing severe nail bed defects. Methods Between May 2009 and January 2012, 16 patients with severe nail bed defect were treated with radial dorsal fasciocutaneous flap of the thumb. There were 10 males and 6 females, aged 16-54 years (mean, 36 years). The causes of injury included crush injury in 10 cases, chainsaw injury in 4 cases, and scald in 2 cases; injured fingers were thumb in 3 cases, index finger in 4 cases, middle finger in 5 cases, ring finger in 3 cases, and little finger in 1 case. The time between injury and operation was 2 hours to 8 days (mean, 19.3 hours). Of 16 patients, 9 complicated by distal phalanx fracture. The area of defect ranged from 0.9 cm × 0.6 cm to 2.3 cm × 2.1 cm. According to ZHOU Qingwen’s grading system for nail bed defects, 6 cases were rated as degree III and 10 cases as degree IV. The area of flap ranged from 1.0 cm × 0.6 cm to 2.5 cm × 2.2 cm. Retrograde transposition was performed to repair the thumb defect, and pedicled transposition to repair the 2nd-5th fingers defects. The donor sites were directly sutured or were repaired with skin graft. Results All flaps and skin grafts survived, and wounds healed by first intention. All patients were followed up 6-12 months (mean, 8 months). The color, texture, and contour of the flaps were good. According to total active motion standard, the finger function was assessed as excellent in 10 cases, good in 4 cases, and fair in 2 cases, and the excellent and good rate was 87.5%. Conclusion Radial dorsal fasciocutaneous flap of thumb is a reliable flap with easy dissection and less trauma in repair of severe nail bed defects.

    Release date:2016-08-31 04:07 Export PDF Favorites Scan
  • TEMPORARY ECTOPIC IMPLANTATION OF AMPUTATED FINGERS AND DORSALIS PEDIS FLAPS FOR THUMB RECONSTRUCTION AND SKIN DEFECT REPAIR OF HANDS

    Objective To investigate the feasibility of temporary ectopic implantation of amputated fingers and dorsalis pedis flaps for thumb reconstruction and skin defect repair of the hand. Methods Between February 2006 and February 2012, 9 patients with thumb amputation having no replanted condition were treated. There were 7 males and 2 females with an average age of 35 years (range, 20-45 years). The injury causes included explosive injury in 1 case, puncher injury in 1 case, stiring machine injury in 1 case, gear injury in 3 cases, and heavy pound injury in 3 cases. At 2-5 hours after injury, one-stage temporary ectopic implantation of amputated finger to foot was performed. After debridement, thumb defect was rated as degree III in 1 case, as degree IV in 3 cases, and as degree V in 5 cases. When amputated fingers survived completely after 1-4 months, the amputated finger was replanted to its anatomic position, skin defect was repaired with dorsalis pedis flap. The area of skin defect ranged from 5 cm × 4 cm to 7 cm × 6 cm. The area of flaps ranged from 6 cm × 5 cm to 8 cm × 7 cm. The donor site was repaired by the skin grafting. Results Arterial crisis occurred in 1 case after 1 day of one-stage operation, and was cured after vascular exploration, and the amputated fingers survived in the others. The reconstructed thumbs and flaps survived after two-stage operation, and the skin graft at donor site survived. The patients were followed up 1-4 years (mean, 2.8 years). The reconstructed thumbs had good appearance and satisfactory opposition and finger-to-finger functions. According to the standard functional evaluation issued by Hand Surgery Association of Chinese Medical Association, the scores of survival fingers were 73-91 (mean, 84); the results were excellent in 7 cases and good in 2 cases with an excellent and good rate of 100%. Conclusion Temporary ectopic implantation of amputated finger to foot combined with dorsalis pedis flap can be used to reconstruct thumb and repair skin defect of the hand.

    Release date:2016-08-31 04:12 Export PDF Favorites Scan
  • 第一掌骨桡背侧穿支皮瓣修复拇指背岛状皮瓣供区

    目的 总结第1掌骨桡背侧穿支皮瓣修复拇指背岛状皮瓣供区的疗效。 方法 2010年1月-2012年7月,收治21例拇指软组织缺损患者。男13例,女8例;年龄17~56岁,平均32.3岁。指端缺损7例,指腹缺损10例,甲床缺损4例。创面范围1.5 cm × 1.5 cm~2.0 cm × 1.8 cm。受伤至入院时间20 min~14 h,平均4.6 h。采用大小为1.8 cm × 1.8 cm~2.3 cm × 2.0 cm的近节指背岛状皮瓣修复创面后,利用大小为1.3 cm × 1.1 cm~2.0 cm × 1.5 cm的第1掌骨桡背侧穿支皮瓣修复供区,穿支皮瓣供区直接缝合。 结果术后拇指背岛状皮瓣和第1掌骨桡背侧穿支皮瓣均顺利成活,创面Ⅰ期愈合。19例获随访,随访时间5~17个月,平均10.4个月。皮瓣血运、弹性好,手指无疼痛。末次随访时,供区皮瓣两点辨别觉为8~12 mm,平均9.6 mm。拇指对掌、对指功能正常。根据中华医学会手外科学会断指再植功能评定试用标准,获优16例,良3例,优良率100%。 结论采用第1掌骨桡背侧穿支皮瓣修复拇指背岛状皮瓣供区,避免植皮后掌指关节背侧瘢痕挛缩,最大限度保留掌指关节功能,穿支皮瓣供区可直接缝合,是一种有效术式。

    Release date:2016-08-31 04:12 Export PDF Favorites Scan
  • 大鱼际微型穿支皮瓣在拇指近节指腹挛缩修复中的应用

    目的 总结大鱼际微型穿支皮瓣修复拇指近节指腹挛缩的方法及疗效。 方法2010年8月-2011年9月,收治拇指近节指腹挛缩患者9例。男6例,女3例;年龄17~60岁,平均45岁。致伤原因:再植术后挛缩 4例,机器绞伤3例,压砸伤2例。瘢痕挛缩3个月~2年。先行挛缩指腹开大,开大后指腹缺损范围为8 mm × 2 mm~30 mm × 15 mm;然后采用大小为25 mm × 10 mm~35 mm × 15 mm的大鱼际微型穿支皮瓣移位修复缺损。供区直接缝合。 结果术后皮瓣完全成活,创面Ⅰ期愈合;供区切口Ⅰ期愈合。患者均获随访,随访时间6~12个月,平均9个月。皮瓣外形良好,质地柔软。拇指背伸80~90°及外展90°。瘢痕无复发;大鱼际切口无瘢痕挛缩,拇指关节活动正常。末次随访时手功能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,获优8指,良1指。 结论大鱼际微型穿支皮瓣具有不损伤主干动脉的优点,是修复拇指近节指腹挛缩的理想方法之一。

    Release date:2016-08-31 04:22 Export PDF Favorites Scan
  • TREATMENT OF ULNAR COLLATERAL LIGAMENT AVULSION FRACTURE OF THUMB METACARP-OPHALANGEAL JOINT USING A COMBINATION OF Kirschner WIRE AND SILK TENSION BAND

    Objective To investigate the effectiveness of Kirschner wire combined with silk tension band in the treatment of ulnar collateral ligament avulsion fracture of the thumb metacarpophalangeal joint. Methods Between September 2008 and October 2011, 14 patients with ulnar collateral ligament avulsion fracture of the thumb metacarpophalangeal joint were treated using a combination of Kirschner wire and silk tension band. There were 8 males and 6 females, aged 23-55 years (mean, 40.8 years). The causes of injury were machinery twist injury in 5 cases, manual twist injury in 4 cases, falling in 4 cases, sports injury in 1 case. The time from injury to operation was 2 hours-14 days. All the patients presented pain over the ulnar aspect of the metacarpophalangeal joint of the thumb, limitation of motion, and joint instability with pinch and grip. The lateral stress testing of the metacarpophalangeal joint was positive. Function training was given at 2 weeks after operation. Results All incisions healed by first intention. The lateral stress testing of the metacarpophalangeal joint was negative. All the patients were followed up 6-18 months (mean, 13.1 months). The X-ray films showed good fracture reduction and healing with an average time of 7 weeks (range, 4-10 weeks). At last follow-up, the thumbs had stable flexion and extension of the metacarpophalangeal joint, normal opposition function and grip and pinch strengths. According to Saetta et al. criteria for functional assessment, the results were excellent in 11 cases and good in 3 cases; the excellent and good rate was 100%. Conclusion It is an easy and simple method to treat ulnar collateral ligament avulsion fracture of the thumb metacarpophalangeal joint using Kirschner wire combined with silk tension band, which can meet the good finger function.

    Release date:2016-08-31 04:22 Export PDF Favorites Scan
  • 改良第一趾蹼皮瓣游离移植修复拇指指腹缺损

    目的 总结吻合血管改良第1 趾蹼皮瓣游离移植修复拇指指腹缺损的疗效。 方法 2008 年2 月-2011 年2 月,收治拇指指腹缺损12 例。男8 例,女4 例;年龄20 ~ 57 岁,平均32.9 岁。机器绞伤7 例,电刨伤3 例,压砸伤2 例。新鲜创面10 例,受伤至入院时间为2 ~ 6 h;陈旧性创面2 例,均为拇指再植术后指腹坏死,于伤后13 d 及15 d 入院。创面范围3.0 cm × 2.0 cm ~ 3.6 cm × 2.8 cm,采用吻合血管改良第1 趾蹼皮瓣游离移植修复,切取的改良皮瓣保留了趾蹼原有功能结构,皮瓣切取范围3.4 cm × 2.3 cm ~ 4.4 cm × 3.0 cm;供区游离植皮或用穿支血管蒂足内侧隐神经营养血管皮瓣修复。 结果 术后供、受区皮瓣和植皮均完全成活,切口Ⅰ期愈合。术后患者均获随访,随访时间8 ~24 个月,平均10 个月。修复后拇指外形美观,伸屈、对掌功能正常,感觉恢复至S3 4 例,S3+ 6 例,S4 2 例。 结论 吻合血管改良第1 趾蹼皮瓣游离移植修复拇指指腹缺损,外形、功能恢复好,供区损伤小,是较好的修复方法之一。

    Release date:2016-08-31 04:23 Export PDF Favorites Scan
  • 第一掌骨一期延长联合虎口加深成形术治疗拇指缺损远期疗效

    目的 总结第1掌骨一期延长联合虎口加深成形术治疗拇指Ⅱ~Ⅲ度缺损的远期疗效。 方法回顾分析1985年8月-1988年8月收治并获24年以上随访的8例拇指Ⅱ~Ⅲ度缺损患者临床资料。男5例,女3例;年龄20~53岁,平均38岁。拇指残端创面愈合至拇指再造时间为4个月~2年,平均9个月。采用第1掌骨截骨后一期延长1.8~2.0 cm再造拇指,同时作虎口“Z”字成形加深术。 结果术后切口均Ⅰ期愈合。随访时间24~26年。再造拇指感觉无异常改变,均能完成对指和握持,不能完成对掌。虎口无继发挛缩,拇指内收、外展活动度30~90°,肌力5~6 级。根据中华医学会手外科学会上肢部分功能评定试用标准评定,均获优良。 结论第1掌骨一期延长联合虎口加深成形术治疗拇指Ⅱ~Ⅲ度缺损,具有手术操作简便、成功率高、远期疗效好等优点。

    Release date:2016-08-31 05:39 Export PDF Favorites Scan
  • RECONSTRUCTION OF THUMB OPPOSITION FUNCTION BY TRANSFERRING EXTENSOR CARPI ULNARIS AND EXTENSOR POLLICIS BREVIS MUSCLE TENDONS

    Objective To evaluate the results of thumb opposition function by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons. Methods Between March 2006 and August 2009, 35 patients with dysfunction of thumb opposition were treated and the thumb opposition function was reconstruced by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons. There were 25 males and 10 females with an average age of 33.5 years (range, 20-53 years); 20 had median nerve injury in the wrist and 15 had median nerve injury with ulnar nerve injury. The causes were sharp instrument injury in 24 cases, blunt injury in 9 cases, and hot crush injury in 2 cases. Six cases complicated by shaft fractures of radius and ulna. All the patients underwent an operation of nerve repair at 1 to 3 hours after injury (mean, 2 hours). The time from injury to reconstructing operation was 6-14 months (mean, 7.5 months). Two cases was able to abduct thumb sl ightly, the others had no functions of thumb abduct and thumb opposition. Results All the wounds gained the primary healing. The patients were followed up 12-18 months (mean, 14 months). The wrist joint angle and thumb dorsal extension were satisfactory. Thumb abduct and thumb opposition function returned to normal in 20 patients with simple median nerve injury; in 15 patients with median nerve injury and ulnar nerve injury, thumb abduct and thumb opposition function returned to normal in 15 and 13, respectively. According to ZHAO Shuqiang’s standard, the results of thumb opposition function were normal in all patients at 12 months after operation. Conclusion It is a convenient and efficient procedure to reconstruct thumb opposition function by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons.

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • IMPROVED INDEX FINGER DORSAL ISLAND FLAP FOR PRIMARY REPAIR OF THUMB TIP INJURY

    Objective To study the improved index finger dorsal island flap for primary repair of thumb tip injury. Methods Between January 2009 and February 2010, 23 patients with thumb tip injury were treated. There were 17 males and 6 females, aged 21-47 years (mean, 27.5 years). The causes of injury were mechanical injury in 18 cases and heavy crushing injury in 5 cases. The time from injury to operation was 2.5-5.0 hours (mean, 3.5 hours). The defect locations included ulnar palmar defect in 5 cases, dorsal foot defect in 6 cases, radial palmar defect in 8 cases, and radial dorsal defect in 4 cases. All patients complicated by exposure of the thumb distal phalanx. The wound area varied from 2.1 cm × 1.8 cm to 2.8 cm × 2.5 cm. According to distal soft tissue defect of thumb, a modified index finger dorsal island flap was designed, key point of which was moved forward, and defects were repaired with the flaps. The size of flap was 2.3 cm × 2.0 cm to 3.0 cm × 2.7 cm. The donor sites were repaired with skin graft. Results All the flaps and grafts survived after operation and the wounds healed by first intention. All patients were followed up 6-12 months with an average of 6.4 months. The appearance and texture of the flaps were excellent. At last follow-up, the sensation of the flaps recovered to S3+ in 18 cases, to S3 in 2 cases, and to S2 in 3 cases. The two-point discrimination was 3-4 mm. Thumb opposition function was normal without contracture at the first web space. The skin graft at the donor site survived completely, and the metacarpophalangeal joint at donor site had the flexion and extension function. Conclusion Using a modified index finger dorsal island flap for primary repair thumb tip injury is a simple operation, which has good blood supply and high survival rate. When the pedicle flap rotation point is moved forward 10 mm or more, it can meet the needs of repairing thumb tip defect.

    Release date:2016-08-31 05:43 Export PDF Favorites Scan
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