跖骨头楔形截骨改善再造手指功能

Wedged osteotomy of metatarsal head to improve reconstructed finger function in toe-to-hand transfer

目的探讨应用跖骨头楔形截骨以改善再造手指功能的手术疗效.方法对36例(42指)行携带跖趾关节的第二足趾游离移植再造手指,术中将跖骨头囊内楔形截骨并沿矢状面由背侧向跖侧旋转90°,改善再造掌指关节的外形和功能.结果 36例(42指)全部成活.术后随访6～36个月,再造手指外形有明显改善.再造指掌指关节从伸直位到掌侧,被动活动范围最大85°,最小70°,平均75°;主动活动范围最大80°,最小55°,平均65°.X线片复查,跖骨截骨面愈合良好.结论应用跖骨头囊内楔形截骨第二足趾移指再造手指,术后改善了再造指的外形和功能,是一种值得推广的手术方法.

Objective To investigate the clinical results of wedged osteotomy of metatarsal head for improving reconstructed finger function in toe-to-hand transfer. Methods This seried involved 42 digits of 36 cases that underwent second toe-to-hand transfer with the metatarso-phalangeal joint. Wedged osteotomy of the metatarsal head was done intracapsularly. The metatarsal head was then rotated from dorsal to plantar along the sagital plane to 90° to correct hyperextension deformity of the reconstructed digit. Results All 42 digits of the 36 cases survived uneventfully. Follow-up ranged from 6 to 36 months. Improved appearance and function were observed. Passive range of motion of the metacarpophalangeal joints averaged 75°, ranging from 70° to 85°. Active range of motion averaged 65°, ranging from 55° to 80°. X-ray taken postoperatively revealed healed bones. Conclusion Intracapsular wedged osteotomy of metatarsal head is an effective way to improve appearance and function of the reconstructed digits in toe-to-hand transfer.