CAJ | 학술논문

目的总结幼儿手背静脉输液渗漏后发生手部挛缩的临床表现及治疗效果,探讨其治疗方法.方法回顾性分析2004年3月至2011年9月治疗手背静脉输液渗漏致手部挛缩并获得随访的6例患儿资料,男3例,女3例；年龄24～51个月,平均38个月；从发生输液渗漏至就诊时间为3～6个月.患儿示、中、环、小指均受累,就诊时掌指关节于0°～l0°位固定,其中中指最严重,中指过伸-20°～0°固定.6例患儿拇指均正常.6例患儿中2例行手背伸肌腱松解、掌指关节背侧关节囊松解术；4例未行手术治疗,仅接受手部康复训练,包括物理治疗(超声波、中频脉冲电治疗等),以促进局部手背肿胀消退、瘢痕软化,同时行手指关节的主被动屈曲功能锻炼,夜间辅助支具固定.结果手术治疗的2例患儿术中掌指关节可被动屈曲90°,术后2个月和6个月随访时均出现挛缩复发,掌指关节于伸直位固定.4例接受康复治疗的患儿随访1～8年,在康复治疗期间掌指关节可主动屈曲30°～45°,停止康复治疗后出现挛缩复发,掌指关节主动屈曲0°～15°.结论幼儿手背静脉输液渗漏致手部挛缩的发生机制尚不清楚,单纯保守及手术治疗远期随访效果均欠佳；临床上应严格掌握保守及手术治疗的适应证,并二者相结合以获得良好的功能恢复.
목적 총결유인수배정맥수액삼루후발생수부련축적림상표현급치료효과,탐토기치료방법.방법 회고성분석2004년3월지2011년9월치료수배정맥수액삼루치수부련축병획득수방적6례환인자료,남3례,녀3례；년령24～51개월,평균38개월；종발생수액삼루지취진시간위3～6개월.환인시、중、배、소지균수루,취진시장지관절우0°～l0°위고정,기중중지최엄중,중지과신-20°～0°고정.6례환인무지균정상.6례환인중2례행수배신기건송해、장지관절배측관절낭송해술；4례미행수술치료,부접수수부강복훈련,포괄물리치료(초성파、중빈맥충전치료등),이촉진국부수배종창소퇴、반흔연화,동시행수지관절적주피동굴곡공능단련,야간보조지구고정.결과 수술치료적2례환인술중장지관절가피동굴곡90°,술후2개월화6개월수방시균출현련축복발,장지관절우신직위고정.4례접수강복치료적환인수방1～8년,재강복치료기간장지관절가주동굴곡30°～45°,정지강복치료후출현련축복발,장지관절주동굴곡0°～15°.결론 유인수배정맥수액삼루치수부련축적발생궤제상불청초,단순보수급수술치료원기수방효과균흠가；림상상응엄격장악보수급수술치료적괄응증,병이자상결합이획득량호적공능회복.
Objective To investigate the clinical manifestation,therapeutic methods and treatmenteffectiveness of hand contracture due to extravasation injury from peripheral intravenous therapy in children.Methods Data of 6 children who had received treatment for hand contracture in our hospital from March 2004 to September 2011 were retrospectively analyzed.There were 3 boys and 3 girls,aged from 24 to 51 months (average,38 months).Two children underwent extensor tenolysis and dorsal capsular release at the metacarpophalangeal (MCP) joints.The other 4 children received conservative treatment,including physical therapy (ultrasound and medium frequency pulse) to reduce the hand swelling and peritendinous adhesion,active and passive functional exercise of digital joints and night splint protection.Results The MCP joint could be passively flexed to 90° intraoperatively in 2 children who underwent operation; however the contracture recurred at 2 months and 6 months after operation,respectively,and then the MCP joints were fixed at 0° position.For 4 children who received conservative treatment,although the active flexion of their MCP joints ranged from 30° to 45° during the rehabilitative procedure,recurrence of hand contracture was observed after the cessation of the rehabilitation in all children,and the range of active MCP joints flexion varied from 0° to 15°.Conclusion The mechanism underlying hand contracture due to extravasation injury from peripheral intravenous therapy remains elusive.Either simple conservative or surgical management results in poor functional outcomes.Combined therapy based on different indications for conservative and surgical management may improve the outcomes.