摘要
目的探讨改良第2足趾近侧趾(指)骨间关节(PIPJ)移植重建手指PIPJ的方法和临床疗效。方法自2017年5月至2020年3月,收治13例手指PIPJ缺损的患者,均为创伤性损伤一期修复术后发生的PIPJ缺损,受伤机制为:绞轧伤5例,电锯伤4例,冲压伤2例,挤压伤2例,其中示指7例,中指3例,环指3例。手术时间为一期手术后3-7个月,应用改良吻合血管的第2足趾PIPJ进行移植重建,取伤指同侧第2足趾10例,取对侧第2足趾3例。移植关节均携带观察皮岛,面积为1.0 cm×1.5 cm~1.0 cm×2.0 cm。足趾供区继发骨缺损均取髂骨条植骨重建,切取髂骨条长度为4.0-6.0 cm,供区创面均采用[母]趾腓侧岛状皮瓣转移修复,面积1.1 cm×1.6 cm~1.1 cm×2.1 cm。术后早期进行功能锻炼,并通过门诊、电话及微信传送照片的方式进行随访,内容包括重建手指和供足的功能、外形恢复情况。结果13例移植的关节和[母]趾腓侧岛状皮瓣均全部成活,移植关节和供趾均骨性愈合,愈合时间为8~12周,平均10周。其中3例关节和肌腱粘连严重,二期行松解术。术后所有患者获得随访10~18个月,重建的指PIPJ未发生退行性变,主动活动度为:屈曲45°-90°,伸直0°-10°,活动度平均66.3°,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:优7例,良4例,可2例。供趾外形良好,远期随访行走功能正常。髂腹股沟供区只留1条线形瘢痕,无明显不适。结论应用改良吻合血管的第2足趾PIPJ移植重建缺损的手指PIPJ,能够恢复手指骨间关节功能,具有良好的效果。足趾供区同时行髂骨条植骨重建加[母]趾腓侧岛状皮瓣转移修复,能够保留足趾的外形和大部分功能,达到供、受区平衡。
Objective To evaluate the clinical effect of the modified transfer of the proximal interphalangeal joint(PIPJ)from the second toe in the treatment of a finger PIPJ defect.Methods A total of 13 patients with finger PIPJ defects caused by traumatic injury were enrolled from May,2017 to March,2020.All the PIPJ defects had primary traumatic repairs.The causes of injury:5 patients were caused by strangulation,4 by chainsaw,2 by strangulation and 2 by crushing.Of which,7 patients had index finger injury,3 middle fingers and 3 ring fingers.The operations were carried out 3-7 months after the first stage of treatment.The grafting of the PIPJ of the second toe with modified vascular anastomosis were performed.The ipsilateral second toe was taken in 10 patients,and the contralateral second toe in 3 patients.The grafted joints all carried observation skin islands,with an area of 1.0 cmxl.5 cm-1.0 cmx2.0 cm.All the secondary bone defects in the donor site of the toe were reconstructed with iliac bone grafts,and the length of the iliac bone strips was 4.0-6.0 cm.At the same time,the island flap on the fibular side of the great toe was removed and repaired at the donor site,with an area of 1.1 cm×1.6 cm-1.1 cm×2.1 cm.Early postoperative rehabilitation was performed.The patients were followed-up through outpatient visits,telephone and WeChat interviews.Results All the 13 finger PIPJ and donor site island flaps survived.Bone healing were observed in all patients with the healing time in 8-12(average 10)weeks.Three patients with severe adhesion of joint and tendon were treated with secondary release.All the patients were followed-up for 10-18 months without degeneration of PIPJ.Active range of motion of PIPJ ranged:45°-90°in flexion and 0°-10°in extension,the average motion activity was 66.3°.Seven patients were in excellent,4 in good and 2 in fair,according to the function assessment proposed by the Society of Hand Surgery of Chinese Medical Association.The appearance on donor site was good and the walking was normal in the longterm follow-up.Only one linear scar was left in the ilioinguinal donor site without obvious discomfort.Conclusion It was possible to use the modified transfer of the PIPJ from the second toe in the treatment of a finger PIPJ defect.An iliac bone graft and an island flap of the first toe transfer can preserve the appearance and function of the toes.
作者
曹学新
陈一衡
涂龙
赵连民
池征璘
CAO Xuexin;CHEN Yiheng;TU Long;ZHAO Lianmin;CHI Zhenglin(Microsurgical and Reconstructive Centre,The Third Hospital of Suqian City,Suqian,Jiangsu Province 223800,China;department of Hand Surgery and Microsurgery,The Second Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejinag Province 325000,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2021年第4期378-383,共6页
Chinese Journal of Microsurgery
关键词
近侧指骨间关节缺损
趾骨间关节
重建
移植
Proximal interphalangeal joint of finger defect
Interphalangeal joint of toe
Reconstruction
Transplantation
作者简介
通讯作者:池征璘,Email:57699788@qq.com,电话:+8613806621111。
