吻合血管的全第二跖趾关节重建掌指关节  

Exploring the operation method of whole second-toe metatarsophalangeal joint to metacarpophalangeal joint

作　　者：施海峰 芮永军 陆征峰 陈光 张全荣 糜菁熠 许亚军 

机构地区：[1]无锡市第九人民医院手外科,江苏214062

出　　处：《中华手外科杂志》2015年第2期119-121,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨跖趾关节全关节移植重建掌指关节的术式。方法自2006年3月至2012年8月，采用吻合血管的第2足趾全跖趾关节原关节重建手指掌指关节外伤性缺损8例，采用蹲甲皮瓣联合第2趾骨、跖趾关节和肌腱再造V度以上拇指重度缺损5例，共13例第2跖趾关节移植的病例，术中未予跖骨头下截骨及跖背侧倒置，术后进行系统康复训练。结果移植的关节全部存活（均携带背侧皮瓣），4例患者分别在术后3～6个月行肌腱粘连松解术。10例经1～5年的随访，主动活动范围最大80°，最小45°，平均60°。按中华医学会手外科学会功能评定试用标准进行评定：优3例，良6例，差1例。结论全跖趾关节原关节移植重建指掌指关节可取得良好的治疗效果。Objective To explore the effects of whole metatarsophalangeal joints transplantation to reconstruct metacarpophalangeal joints. Methods From March 2006 to August 2012, 8 patients received metatarsophalangeal joints of the second-toe transplantation to reconstruct the metacarpophalangeal joints. 5 patients with level V thumb defect were given a comprehensive transplant surgery consisting of the wraparound flap of the first toe and all bone, joints and tendons of the second toe. None of the 13 patients received osteotomy beneath the head of metatarsus and palm dorsal inversion. All eases underwent a systematic protocol of rehabilitation after operations. Results All transplants survived, of which 4 cases received tenolysis 3 to 6 months after operations. In 10 patients after 1 to 5 years follow-up, the average active joint motion was 60° （range, 45°to 80°）. The outcomes were graded as excellent in 3 cases, good in 6 cases, and poor in 1 case according to the provisional functional assessment criteria for upper limbs issued by the Hand Surgery Society of Chinese Mledical Association. Conclusion Metatarsophalangeal joints transplantation to reconstruct metacarpophalangeal joints is an effective method without osteotomv and oalm dorsal inversion.

关 键 词：掌指关节 移植 跖趾关节 显微外科手术 

分 类 号：R684.7[医药卫生—骨科学]