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掌腱膜挛缩症.doc

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掌腱膜挛缩症.doc
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掌腱膜挛缩症的临床及病理基础 文章来源: 2006-7-26 16:46:42 掌腱膜挛缩症的临床及病理基础中国矫形外科杂志 2000 年第 9 期第 7 卷 论著作者:潘志军 黄宗坚 吴立东 徐侃 戴雪松单位:浙江大学医学院附属第二医院骨科,杭州 310009关键词:Dupuytren′s 挛缩;病理;治疗;手术后复发摘 要 目的:探讨掌腱膜挛缩症的病理改变与疗效之间的关系,为合理选择手术方式提供依据。方法:对 26 例掌腱膜挛缩症患者共 29 只手进行手术治疗,其中 12 只手单纯作掌腱膜切除术,17 只手行掌腱膜切除+受累皮肤切除术,对其疗效进行平均 4.6 年的随访;并对 24 例掌腱膜标本作病理学及免疫组化检测。结果:所有行免疫组化检测的病变掌腱膜标本中均有 α-平滑肌肌动蛋白的表达;单纯掌腱膜切除组的术后复发率为 58.33%,掌腱膜切除+受累皮肤切除组术后复发率 11.76%。结论:掌腱膜挛缩症的病理改变不仅仅局限在掌腱膜,也可累及皮下组织和皮肤。因此,对病变已侵及皮肤的病例应作掌腱膜切除+受累皮肤切除术。中图分类号 R686.1 文献标识码 A文章编号 1005-8478(2000)09-0842-03The Clinical and the Related Pathology of Dupuytren′s ContracturePAN Zhi-jun,HUANG Zong-jian,WU Li-dong,et al.(Department of Orthopaedics,The Second Affiliated Hospital,Medical College of Zhejing University,Hangzhou, 310009.)Abstract Objective: To observe the possible relationship between the clinical and pathology changes of Dupuytren′s Contracture,and to obtain the reasonable surgical procedures.Methods: 29 hands of 26 patients with Dupuytren′s Contracture treated with surgery were reviewed.12 hands had been performed the fasciectomy,the dermofasciectomy in 17 hands.The average follow-up period was 4.6 years.The pathological and immunohistochemical examination had been performed in 24 cases.Results: The expression of α-smooth muscle actin was observed in all the specimens.The recurrence rate after fasciectomy was 58.33%,and the rate of recurrance after dermofasciectomy was 11.76%.Conclusion: The pathology changes located not only at the palmar aponeurosis but also in the subcutaneous tissue and overlying skin.The dermofasciectomy should an alternative procedure in case of skin involved.Key words Dupuytren′s Contracture Pathology Surgery Postoperative recurrence掌腱膜挛缩症(Dupuytren′s Contracture)是一种侵犯掌腱膜,并延伸至手指筋膜,最终导致掌指及指间关节挛缩的进行性发展的疾病。1614 年 Plater 首先认识此病,1831 年 Dupuytren较全面地描述了此病,并提出手术治疗,但术后复发率较高。我院自 1990~1999 年收治掌腱膜挛缩症 26 例,不同的手术方法其疗效不同。1 临床资料1.1 一般资料本组共 26 例 29 只手,男 25 例,女 1 例。年龄 48~73 岁,平均 62.16 岁;病程 1~10 年,平均 4.2 年;平均发病年龄 57.96 岁。左手 8 侧,右手 21 侧。脑力工作者 7
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