拆分第二足趾修复两个相邻掌指关节背侧复合组织缺损  

Simultaneous reconstruction of composite tissue defects in two adjacent metacarpophalangeal joints of hand by split the 2nd toes

作　　者：李卫[1] 刘金伟[1] 何藻鹏[1] 蔡厚洪 林绍仪 吴举[1] 李春雨[1] 梁观钦 

机构地区：[1]广东省创伤救治科研中心乐从临床基地佛山市顺德区乐从医院手足外科,广东省佛山市528315

出　　处：《中华显微外科杂志》2012年第6期460-463,I0005,共5页Chinese Journal of Microsurgery

基　　金：广东省医学科学技术研究基金项目（A2012674）

摘　　要：目的探讨第二足趾拆分、修复两个相邻掌指关节背侧复合组织缺损的新术式及疗效。方法从2006年12月到2011年12月间，对7例14个掌指关节缺损患者，设计应用以足背动脉一第一、二跖背动脉一趾背动脉为蒂的第二足趾，将其拆分成以足背动脉一第一跖背动脉一第二足趾胫侧趾背动脉为蒂的第二跖趾关节复合组织瓣及以足背动脉一第二跖背动脉一第二足趾腓侧趾背动脉为蒂的第二趾近侧趾间关节复合组织瓣，经过重建，保留复合组织瓣背侧半，同时修复两个相邻掌指关节背侧复合组织缺损。结果本组7例14个掌指关节。12个关节移植成功，2个关节因第一跖背动脉变异而放弃趾间关节组织瓣。全部病例得到随访，随访时间6～24个月，x线提示骨折愈合。按中华医学会手外科分会拇、手指再造功能评定试用标准，优良率为83．33％。结论第二足趾拆分、重建同时修复两个相邻掌指关节背侧复合组织缺损临床可行，能有效改善损伤掌指关节的功能。Objective To explore the efficacy of simultaneous reconstruction of composite tissue de- fects in two adjacent metacarpophalangeal joints of hand by split the 2nd toes. Methods From December 2006 to December 2011, the second toe composite flap pedicled with the dorsalis pedis artery- first, second metatarsal dorsal artery-dorsal artery were designed, and split it into the second metatarsophalangeal joint composite flap pedicled with the dorsalis pedis artery-first dorsal metatarsal artery-tibial artery and the proxi- mal interphalangeal joint composite flap pedicled with dorsalis pedis artery-second dorsal metatarsal artery- fibular dorsal artery. Then they were used to repair composite tissue defects in two adjacent metacarpopha- langeal joints of hand at the same time after reconstruction. Results This group includes 14 metacarpopha- langeal joints of 7 cases, twelve joints was successful, two joints of 1 case to give up because the first dorsal metatarsal artery variation. At 6-24 months follow-up study in 12 out of 14 cases showed that there was no joint degeneration in X - ray manifestation and the recovering of joint function was satisfying. According to the function evaluation standard of reconstraction of thrumb and finger issued by Hand Surgery Society Chi- nese Medical Association, the excellent and good rate was 83.3%. Conclusion It is feasible to reconstruct of composite tissue defects in two adjacent metacarpophalangeal joints of hand at the same time by split the 2nd toes, and can effectively improve the functions of injury metacarpophalangeal joint.

关 键 词：掌指关节 一蒂双瓣 跖趾关节 趾间关节 移植 

分 类 号：R658.3[医药卫生—外科学]