掌腱膜部分切除术与掌腱膜切除加受累皮肤切除及皮肤移植术治疗掌腱膜挛缩症的比较

摘要

Objective Investigate the clinic results of palmare fascia partial excision and palmare fascia excision and skin transplantation surgical treatment methods of Dupuytren’s contracture, to explore the best treatment. Methods Sixty-three patients(85 hands) with Dupuytren’s contracture treated by operation were reviewed. Among 25 patients(34 hands) treated with palmare fascia partial excision, 19 patients were male and 6 patient were female, wtih an average age of (52.4±10.5) years ranging from 18 to 68 years. Within another 38 patients (51 hands) treated with palmare fascia excision and skin transplantation, 31 patients were male and 7 patients were female, with an average age of (56.3±14.6) years ranging from 22 to 74 years. Results All the patients were followed up averagely for six years and two months, ranging from 4 months to 12 years. The postoperative recurrence rates were 44.12%(15/34) and 13.72%(7/51) in the patients treated with palmare fascia partial excision and those treated with palmare fascia excision and skin transplantation. The Chi-square test was used to compare statistically the recurrence rate between the two groups and the result showed theχ2=9.823, P value was less than 0.01 (P=0.002). Conclusion Palmare fascia excision and skin transplantation is effective to decrease postopemtive recurrence rate in the treatment of Dupuytren’s contracture.%目的探讨掌腱膜部分切除术与掌腱膜切除加受累皮肤切除及皮肤移植术这两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。方法总结和分析经手术治疗的掌腱膜挛缩63例(85只手)。行掌腱膜部分切除术25例(34只手)，男19例，女6例；年龄18~68岁，平均（52.4±10.5）岁。行掌腱膜切除加受累皮肤切除及皮肤移植术38例(51只手)，男31例，女7例；年龄22~74岁，平均（56.3±14.6）岁。结果随访4个月~12年，平均6年2个月。掌腱膜部分切除术组术后复发率为44.12%(15/34)，掌腱膜切除加受累皮肤切除及皮肤移植术组术后复发率为13.72%(7/51)，运用SPSS19.0统计软件以卡方检验对两组间复发率的差异作统计学处理，χ2=9.823，P<0.01（P=0.002），两组术后复发率差异有显著性意义。结论掌腱膜切除加受累皮肤切除及皮肤移植术有利于降低手术的复发率。