足趾移植再造拇、手指400例报告  

Thumb and finger reconstruction by toe transplantation:a report of 400 cases

作　　者：顾玉东[1] 陈德松[1] 张高孟[1] 成效敏[1] 徐建光[1] 杨学斌[1] 张丽银[1] 蔡佩琴[1] 

机构地区：[1]上海医科大学华山医院手外科,河南洛阳医专附属医院

出　　处：《中华手外科杂志》1995年第4期195-199,共5页Chinese Journal of Hand Surgery

摘　　要：总结１９６６年２月至１９９４年２月的足趾移植术４００例，以正确评估足趾移植在拇、手指再造中的作用．再造方法：单纯第２趾移植（带或不带跖趾关节）２９９例，第２、３趾联合移植２８例，第２趾带第３趾近节趾骨１例，第２趾伴各种皮瓣移位或移植６６例，甲瓣伴第２趾或２、３趾移植６例。移植成活３８６例，失败１１４例，成活率为９６．５％。２４０例获得２年以上的功能随访，再造指的运动与感觉功能优良率达９０％以上，足的功能满足率达８６％～９１％。对各种再造方法的手术指征，血循危象的防治，提高功能效果的关键及趾移植后足的功能影响等进行了详细分析。总体评价为：（１）足趾移植是再造拇、手指比较理想的方法。（２）单纯切除第２趾不论跖骨头是否保留均不造成足的功能及生物力学的明显改变。（３）随着足部切除组织的增加，术后足的外形、功能及生物力学的变化也加大。cases of toe transplantation from Feb. 1966 to Feb. 1994 were analyzed to evaluate the value of toe transplantation in thumb and finger reconstruction. The methods included: single second toe transplantation (with or without metatarsophalangeal joint ) in 299 cases, second and third toe transplantation in 28 cases. second toe and third proximal phalanx transplantation in 1 case, second toe with various flap transfer in 66 cases, hallux nail flap with second toe or second and third toe transplan tation in 6 cases. 386 cases survived and 14 cases failed. The survival rate was 96. 5 %. 240 cases were followed up for more than 2 years. The excellent rate of the motor and sensory function of reconstructed finger or thumb was greater than 90%. The satisfactory rate of foot function reached 86 % to g1%.The surgical indications for each method, the prevention of vascular crisis, the points for improving function and the influences of foot function after toe transplantation were analyzed. The conclusions were: (1)Toe iran.splantation is a satisfactory method for thumb and finger reconstruction. (2 ) Single second toe resection with or without metatarsal head cioes not impair the function or biomechanics of the foot significantly. (3)The more tissues sacrificed in foot, the greater influence on the configuration,function and biomechanics of the foot.

关 键 词：拇指再造 手指再造 足趾移植 

分 类 号：R658.205[医药卫生—外科学]