游离带关节的第二足趾复合组织移植修复手指关节洞穿伤  

Repair of perforated fingers using composite tissue transplantation of articulated second toe

作　　者：巨积辉[1] 金光哲[1] 刘跃飞[1] 李雷[1] 赵强[1] 魏诚[1] 李建宁[1] 刘新益[1] 侯瑞兴[2] 

机构地区：[1]苏州瑞兴医院手外科,215128 [2]苏州大学附属第一医院骨科

出　　处：《中华创伤骨科杂志》2009年第1期11-14,共4页Chinese Journal of Orthopaedic Trauma

基　　金：基金项目：苏州市科技计划资助项目（SS0714）

摘　　要：目的探讨应用带关节的第二足趾复合组织移植修复手指关节洞穿伤的疗效。方法2001年7月至2008年1月，应用带血供的第二足趾复合组织游离移植修复14例洞穿伤造成的手指不同部位复合组织缺损患者，男11例，女3例；平均年龄25．4岁。应用第二足趾近侧趾问关节全关节移植5例，半关节移植3例；应用第二足趾跖趾关节全关节移植2例，半关节移植4例。术后2周开始进行康复功能锻炼。结果1例小指掌指关节部位缺损移植患者皮瓣部分坏死，经换药后伤口愈合，术后8个月随访，掌指关节愈合良好；其余13例患者移植复合组织均一期成活，术后经6～15个月（平均11个月）随访，移植骨关节愈合良好，无骨不连、骨畸形愈合等发生，无关节退行性变现象出现，移植手指功能恢复满意，伤指均可完成对指动作。按照中华医学会手外科学分会手功能评价标准评定：优4例，良6例，可4例。结论应用游离第二足趾复合组织移植修复手指关节洞穿伤，可一次手术完成骨、关节、肌腱、皮肤等复合组织的缺损修复，最大限度地恢复伤指关节功能。Objective To evaluate the repair of perforated fingers using complex tissue transplantation of articulated second toe. Methods From July 2001 to January 2008, complex tissue grafts of articulated second-toe with blood supply were used to repair 14 cases of perforated finger defects, 11 males and 3 females. Their average age was 25.4 years old. Using the proximal interphalangeal joint of the second toe, total joint transplantation was conducted in 5 cases and half joint transplantation in 3 cases. Using the metatarsophalangeal joint of the second toe, total joint transplantation was performed in 2 cases and half joint transplantation in 4 cases. Results Primary healing of the grafted complex tissues was achieved in 13 cases, though partial necrosis of skin flap was observed in 1 patient with a defect at the metacarpophalangeal joint of the little finger, whose wound healed after change of dressings. In the other cases, followed up for 6 to 15 （average, 11 ） months, the grafts had satisfying appearance and fine healing of joints. No nonunion, bone deformity or degeneration of joints was present. Finger functions were favorably recovered, and finger to finger activity was achieved. According to the criteria for hand functions by Chinese Medical Association, 4 cases were excellent, 6 fine, and 4 fair. Conclusion Repair of perforated fingers using composite tissue grafts of the second toe is a one-off repair of defects of bone, joint, tendon, skin and other tissues, providing fine rehabilitation for each subtle defect and maximizing functional recovery of injured fingers.

关 键 词：指损伤 掌指关节 指关节 组织移植 显微外科手术 

分 类 号：R686[医药卫生—骨科学]