游离甲瓣联合第2趾骨复合组织瓣再造拇指  

The hallux wrap-around flap combined with the modified second toe bone flap to reconstruct the thumb

作　　者：张俊[1] 王群殿 于涛 袁云华 李凯 王健 ZHANG Jun;WANG Qundian;YU Tao(Department of Orthopaedics, Shanghai Pudong New Area Peopled Hospital, Shanghai, 201299, China)

机构地区：[1]上海市浦东新区人民医院骨科

出　　处：《实用手外科杂志》2019年第2期138-140,238,共4页Journal of Practical Hand Surgery

基　　金：上海市浦东新区科技发展基金项目(项目编号:PKJ2017-Y33);上海市自然科学基金面上项目(项目编号:16ZR1444600)

摘　　要：目的探讨游离甲瓣联合改良或未改良第2趾骨复合组织瓣再造拇指的疗效。方法 2012年1月-2018年6月对17例拇指Ⅲ~Ⅴ度缺损患者采用游离甲瓣联合第2趾骨复合组织瓣再造,按是否对第2趾骨进行改良分为改良组(8例)和传统组(9例),术后随访外观满意度、功能评定及供区并发症。结果 17例再造拇指均成活,随访6~24个月,改良组外观满意度(94.4±5.6)分,传统组(90.6±6.3)分,两组比较差异无统计学意义。两组拇指对掌、对指功能良好,感觉恢复良好。供足功能及外形均恢复理想,步行无明显疼痛及跛行。按中华医学会手外科学会上肢部分功能评定试用标准评定:改良组优6例,良2例;传统组优6例,良3例。结论游离甲瓣联合第2趾骨复合组织瓣再造拇指能同时恢复拇指的外形与功能,是拇指缺损再造的有效方法之一,改良方法适用于第2趾较长的患者。Objective To investigate the effect of the hallux wrap-around flap combined with modified or unmodified second toe bone flap for reconstruction of thumb. Methods From January 2012 to June 2018, 17 patients with Ⅲ~Ⅴ degree defect of thumb were reconstructed with hallux wrap-around flap combined with second toe bone flap. According to whether the second toe bone was modified or not,they were divided into two groups(modified group, 8 cases) and(traditional group, 9 cases). The postoperative follow-up included appearance satisfaction, functional evaluation and complications. Results All thumbs survived, and they were followed up from 6 to 24 months. The appearance satisfaction of the modified group was(94.4±5.6) points, while that of the traditional group was(90.6±6.3) points, there was no significant difference between two groups. The thumb to finger and opposition function was good and the sensation recovered well in the two groups. The function and appearance of the donor foot restored to normal, and there was no obvious pain and limp during walking. According to the Chinese Medical Association evaluation standard of thumb and finger reconstruction: excellent in 6 cases and good in 2 cases in the modified group while excellent in 6 cases and good in 3 cases in the traditional group.Conclusion The hallux wrap-around flap combined with second toe bone flap can restore the appearance and function of thumb. It is one of the effective methods for reconstruction of thumb defect. The modified method is suitable for patients with long second toe.

关 键 词：甲瓣 第2趾骨 拇指 再造 

分 类 号：R658.2[医药卫生—外科学]