足趾移植再造部分手指24例报告  

Evaluation of clinical results of lesser toe transplantation for segmental finger reconstruction

作　　者：曹显科[1] 康庆林[1] 李铮[1] 林胡梅 牟英[1] 

机构地区：[1]解放军107中心医院急诊外科,山东烟台264002

出　　处：《实用骨科杂志》2002年第4期261-262,共2页Journal of Practical Orthopaedics

摘　　要：目的 :探讨影响足趾再造部分手指外形和功能的关键因素 ,为指导临床治疗提供依据。方法 :通过对 2 4例3 7指指再造的手术经验和足趾与手指的比较 ,对足趾移植再造部分手指的适应证、手术方法以及“驼背”畸形的预防进行分析 ,并探讨改善再造指外形的整形方法和促进其感觉恢复的手段。结果 :足趾移植再造部分手指适合于远侧指间关节以远的急诊毁损伤 ,供趾选择应按照优势侧动脉相吻合的原则。在骨关节重建时 ,应注重近侧指间关节的保留和重建 ,将趾短伸腱与受区侧腱束吻接有助于预防再造指“驼背”畸形。对供趾趾腹和趾根跖侧整形 ,可使再造指获得逼真的外形。术后感觉再教育是促进再造指感觉功能恢复的重要保证。结论 :足趾移植再造部分手指单纯追求成活并不困难 ,但是要想获得良好的外观和功能 ,必须对诸多相关问题进行妥善处理。Objective:To investigate the factors affecting the appearance and function of reconstructed fingers using lesser toes transfer and provide the direction for transfer surgery.Methods:According to the experience of 28 patients with 39 lesser toe-to-fingers transfer as well as the anatomical discrimination of lesser toe and finger,the transfer indication,operation technique and hump finger deformity prevention were retrospectively analyzed,simultaneously the appearance improving method and how to stimulate sensation recovery were explored.Results:Lesser toe-finger transfger was optimal for reconstruction the injury of distal to the proximal interphalangeal joint,the donor toe selection should adhere to the law of dominant artery interanastomosis.When bone and joint were repaired,the proximal interphalangeal joint must be maintained or reconsturcted.Suturing of the extensor digitorum brevis to the recipient zone interosseous musculotendinous structure,helped to prevent the 'camel hump' appearance of the new fingers.Reducing the donor toe pulp and plantar of toe root contouring procedure were very crucial to aesthetic appearance of new fingers.The postoperative sensory reeducation could promote their sensation revovery.Conclusion:It is not difficult to guarantee the survival of reconstructed finger form toe transfter,but the attainment of good appearance and function is depended on appropriate treatment with every relevant factor.

关 键 词：足趾移植 显微外科 手指再造 适应证 关节重建 

分 类 号：R658.1[医药卫生—外科学]