冷冻异体手指复合组织移植再造拇指200指  

Two hundred thumb reconstructions with frozen Phalanx-joint-tendon composite tissue allograft

作　　者：侯明钟[1] 黄硕麟[1] 袁启智[1] 黄燮青[1] 缪勇[1] 滕可颖[1] 蔡燕娴[1] 贾万新[1] 黄一雄[1] 章开衡[1] 

机构地区：[1]上海市第一人民医院整形外科

出　　处：《中华手外科杂志》1995年第4期207-210,共4页Chinese Journal of Hand Surgery

摘　　要：对１９７例拇指Ⅲ～Ⅳ；级缺失者，采用自体甲瓣游离移植包裹冷冻异体手指的复合组织（骨、关节、肌腱、腱鞘）再造拇指２００指。笔者认为冷冻能降低异体手指组织的抗原性，术前、后不用抑制排异反应的制剂与激素，无急性排异反应发生。手术成功率９６．４％，异体手指存活率９１．５％。术后３个月感觉恢复，测定对掌功能１４４例，优良率为９１．６％。平均随访时间４年５个月，部分病例远期出现异体骨吸收及关节变性，可能与骨片来镶嵌好，术后活动过早及慢性排异有关；但主要是移植组织未及时恢复神经血管的营养支配有关。为此取甲辩时内附着趾关节２块骨片，挖去异体指骨内骨髓，植入自体新鲜红骨髓及松质骨，有利于血管长入异体骨及促进宿主对其爬行替代。提出合理设计供足趾胫侧的保留皮瓣，尽量维持趾长度，供皮瓣区中厚皮片植皮，保存第１背侧跖骨肌及附内外侧血管及足背皮神经，可减少足的并发症。Two hundred thumb reconstructions with frozen phalanx-joint-tendon composite tissue allograft in 197 cases were reported. The success rate was 96. 4 % and the survival rate of the allograft was 91. 5%. The follow-up period ranged from three months to twelve years with an average of four years. The immunoreaction was believed to be reduce by deep refrigeration and preservation. Bone ababsorption or joint destruction occurred in some cases which might be related to host immune response or lack of innervation-revascularization. This could be improved by inlaying to each allogeneic phalanx a piece of autogenous vascularized phalanx with the free hallux flap. The marrow cavities of the allografts were filled with auto-red marrow or auto-caneilous bone from the radius, which is useful to osteogeneosteogenesis. Following points should be noted to prevent complications: 1. Proper design of tibial flap of the donor hallux. 2. Retaining of the length of the hallux. 3. Preservation of the first dorsal interosseous muscle of the foot. 4. Preservation of the lateral and medial tarsal arteries.

关 键 词：拇指再造 冷冻异体手指 组织移植 

分 类 号：R658.205[医药卫生—外科学]