冷冻异体手指复合组织移植的临床评价  

CLINICAL EVALUATION OF FROZEN PHALANX JOINT TENDON SHEATH COMPOSITE TISSUE ALLOGRAFT

作　　者：侯明钟[1] 黄燮青[1] 贾万新[1] 滕可颖[1] 胡必寺[1] 蔡燕娴[1] 王岚[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科,上海200080

出　　处：《中国修复重建外科杂志》2000年第4期245-248,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的　评估自体口止母甲皮瓣游离移植包裹冷冻异体手指骨 -关节 -肌腱 -腱鞘复合组织再造拇、手指的临床效果。方法　对再造拇、手指 2 70例通过门诊复查、信访、X线片、实验室检查、99m Tc MDP扫描及手术等方式进行随访 ,并对资料进行统计学处理与临床验证。随访时间为术后 5个月～ 16年 ,平均 5年。结果　 口止母甲皮瓣携带趾关节二块骨片包绕营养异体手指复合组织能造出外形良好的拇、手指 ,对掌功能优良率 71.91%。感觉在术后3～ 8个月恢复 ,两点辨别觉 3～ 15 m m。自体趾骨片镶嵌异体指骨能促进异体骨与宿主骨的连接。 2 4例术后 4个月～ 9年 7个月进行　 99m Tc MDP检查显示 :移植手指的放射性核素分布与健指相似 ,表明异体骨血运建立。但冷冻仍难避免部分异体关节的变性与骨吸收 ,呈现类似关节失神经血管营养支配的 Charcot氏关节炎病变。这与关节的活动磨损或宿主的慢性排异反应有关。结论　该术式适用于任何程度的拇、手指缺损修复 ,自体足趾损失较少 ;口止母甲皮瓣内趾骨片镶嵌异体骨有利于宿主骨的爬行替代和连接 。Objective\ To evaluate clinical result of reconstructed thumb and finger with a free hallux nail flap(HNF) and frozen phalanx joint tendon sheath composite tissue allograft in 270 cases. Methods\ The patients were followed up with reexamination in the ambulant clinic, communication, X ray photography, lab examination, isotope\ 99m Tc MDP and reoperation. The data were analyzed by statistics or proved by clinical observation, which were followed up for five years in average (ranging from five months to sixteen years).Results\ Enveloping the allogeneic finger composite tissue with self HNF and pieces of phalanx of great toe, it could reconstruct a thumb or finger with good contour and nutrition. The excellent rate of opposition function of the reconstructed thumbs was 71.91%. The sense of the fingers recovered after 3 months to 8 months of operation. Two point discrimination was 3 mm to 15 mm. The junction between implanted allo phalanges and auto phalanges could be hastened by implanted with vascularized autogenous phalanx pieces in the HNF. The isotope 99m Tc MDP was used to take X ray photography in 24 cases for four months to 9 years and seven months,which showed that the blood vessles grew into the allo phalanges. However, the Charcot's arthropathy of allogeneic joints and bony absorption still could be seen in some cases. That might be concerned with chronic abrasion of joint or chronic rejection of host to graft.Conclusion\ The operation is fit for repairing the defect of thumb or finger in any degree. The implanted vascularized self phalanx pieces can promote bone union, but it can not prevent the allogeneic joints from arthropathy or bone absorption.

关 键 词：皮瓣 冷冻手指 异体移植 复合组织移植 

分 类 号：R658[医药卫生—外科学]