제 1수지간 구축 정도에 따른 교정 전략

Abstract

Adequate first web space is essential for web space expansion, thumb abduction, and a wide range of thumb mobility and hand function activities. First web space contracture is caused by burns, trauma, infection, arthritis, ischemia, paralysis, spastic conditions, improper splinting, Dupuytren's contracture, or congenital anomaly. We have treated 18 cases of first web space contracture from Nov. 1, 1996 to Apr. 30, 2000 using 23 various flaps. Four measurements such as maximal abduction angle, maximal abduction distance, radial abduction angle, and palmar abduction angle were examined preoperatively and postoperatively. We have classified first web space contracture as mild, moderate, or severe depending upon the magnitude of contracture and scarring of the first web contents (skin, fascia, muscle and joint capsule). We have performed hree Z-plasty, three double opposing Z-plasty, and two 4 flap Z-plasty in 6 mild contracture. We have performed two Z-plasty and F.T.S.G, two dorsal rectangular flap and F.T.S.G, two F.T.S.G, and two S.T.S.G in 5 moderate contracture. We have performed two distant flaps and five free flaps in 7 severe contracture. Periods of follow-up were from 12 months to 35 months with an average of 15 months. Every patient was analyzed by the ratio of postoperative measurements to preoperative measurements. The mean ratios of mild, moderate, and severe contracture were 1.33, 1.28, and 1.38 respectively. Although first web space contracture was severe, its ratio was more improved than that of mild or moderate contracture because of complete release and abundant soft tissue coverage such as first web space free flap. The proper methods of first web space contracture release in accordance with the classification allowed to achieve excellent results.

저자들은 본원에 내원한 제 1수지간 구축환자를 반흔구축 범위, 구축을 해리할 때 예상되는 결손정도 등을 기준으로 경도, 중등도, 심도로 분류하였다. 즉 경도는 구축이 피부에 국한되어 있고 최대외전각도가 60도, 요골외전각도가 50도 이상으로, 중등도는 피부뿐 아니라 심근막에도 손상이 있고 최대외전각도가 45-60도, 요골외전각도가 40-50도로, 심도는 피부, 심근막, 제 1수지간 근육과 관절에 변형이 있는 예로 최대외전각도가 45도, 요골외전각도가 40도 이하인 경우로 분류하였다. 수술은 경도의 구축은 여러 가지 Z성형술을, 중등도는 식피술을 보강한 Z성형술 혹은 식피술 단독으로 사용하였고, 심도의 구축은 원거리피판술이나 유리피란술을 사용하였다. 술후 4가지 항목의 술전 값에 대한 술후 값의 평균비는 경도, 중등도, 심도에서 각각 1.33, 1.28, 1.38로 크게 향상되었다.