带皮瓣的第二跖趾及近侧趾间关节移植重建拇指掌指及指间关节缺损  

Repair of metacarpophalangeal and interphalangeal （thumb） joint defect using the second toe metatarsopha- langeal and proximal interphalangeal joint transplantation with skin flap

作　　者：刘铭波 李保龙 叶伟德 梁勇 王江龙 马立峰 杨延军 张子清 

机构地区：[1]深圳市龙岗区骨科医院手外科,广东省深圳市518116

出　　处：《中华显微外科杂志》2016年第5期420-423,共4页Chinese Journal of Microsurgery

基　　金：深圳市龙岗区科技计划医疗卫生项目（YS2013102）

摘　　要：目的探讨带皮瓣的第二跖趾及近侧趾间关节移植重建拇指掌指及指间关节的手术方法及临床效果。方法2012年5月至2015年6月，采用带皮瓣的第二跖趾及近侧趾间关节移植重建拇指掌指及指间关节缺损12例。患者年龄19~49岁；致伤原因：电刨伤5例，电锯伤3例，冲床冲压伤2例，热压伤2例。掌指关节及指间关节缺损总长度为4.5~7.0 cm，皮肤软组织缺损范围5.5 cm × 2.5 cm^8.0 cm × 5.5 cm。术中行第二趾跖趾关节跖板前移术，前移距离3.0~5.0 mm，皮瓣切取范围6.0 cm × 3.0 cm^8.5 cm × 6.0 cm。供区行截趾，其中6例创口直接缝合；6例先行部分创口缝合，残存创面行小腿取皮植皮处理。术后行系统康复训练。结果移植骨关节均愈合（骨性愈合时间为7~12周），未出现骨不连及再骨折。皮瓣全部成活，供区一期愈合。术后随访8~33个月，平均17.5个月。移植的掌指关节活动度伸-10°~0°，屈曲60°~80°，平均（70 ± 10）°；指间关节活动度达40°~60°，平均（50 ± 10）°。足部供区的行走、跑跳功能无影响。按关节活动度TAM/TAF评定标准评定：优8例，良4例。结论带皮瓣的第二跖趾及近侧趾间关节移植重建拇指掌指及指间关节缺损可取得良好的治疗效果。Objective To investigate the surgical methods and clinical effect of reconstructing the metacarpophalangeal and interphalangeal joint defect of thumb with transplantion of the second toe metatarsophalangeal joint and proximal interphalangeal joint with skin flap. Methods From May, 2012 to June, 2015, 12 patients received the second toe metatarsophalangeal joint flap and proximal interphalangeal joint transplantation to reconstruct metacarpophalangeal joint and the interphalangeal joint defects of thumb. Patients aged 19 to 49 years. Causes of injury： planer injury in 5 cases, 3 cases chainsaw, punch punching injuries in 2 cases, 2 cases of hot crush. The metacarpophalangeal and interphalangeal joint defects were 4.5 -7.0 cm in size, combined with skin and soft tissue defect were 5.5 cm × 2.5 cm- 8.0 cm× 5.5 cm. Intraoperative second toe metatarsophalangeal joint plantar plate transposition, forward distance of 3.0 mm to 5.0 ram. The skin flap ranged from 6.0 cm × 3.0 cm to 8.5 cm ×6.0 cm. The donor site of 12 cases received toe amputation. Six cases of wound suture; 6 cases of the first leg wound for residual wound suture, take a skin graft treatment. All cases underwent a systematic protocol of rehabilitation after operation. Results All transplanted joints and skin flaps survived. All transplanted bones and joints healed（bones healing time was 7 to 12 weeks）. All incisions and donor sites healed by first intention. All cases were followed up for 8 to 33 months （mean, 17.5 months）. The metacarpophalangeal joint of 12 transplanted extension between -10° and 0°, and flexion between 60°and 80°, average （70 ± 10）°; the interphalangeal joint activity at 40° to 60 °, average （50 ± 10）°. Graded according to TAM/TAF scale, the outcomes were excellent in 8 cases, good in 4 cases. Conclusion Repair of metacarpophalangeal and interphalangeal （thumb） joint defect using the second toe metatarsophalangeal and proximal interphalangeal joint transplantion with skin flap enables favorable func

关 键 词：拇指 掌指关节 跖趾关节 关节移植 显微外科手术 

分 类 号：R687.4[医药卫生—骨科学]