第二跖趾关节移植在掌指关节重建中的应用

Transfer of metatarsophalangeal joint from the second toe for metacarpophalangeal joint reconstruction

目的 探讨第二跖趾关节游离移植重建掌指关节的新方法。方法 通过对成人废弃下肢标本6侧，在放大6，10倍手术显微镜视下，解剖并观察第二跖趾关节血供及测量关节活动范围的应用解剖学研究，并在该研究基础上，临床采用不同术式的第二跖趾关节移植，修复掌指关节缺损34例。其中对第一掌指关节重建，将游离关节的跖骨直接与掌骨成30°～45°固定。对2—5指掌指关节重建，采用跖骨头下关节面45°截骨，同时将过厚的跖板在保留关节囊完整及部分跖侧屈肌腱鞘的情况下作楔形切除，原跖骨断端重新对合，纵行克氏针固定。结果 术后34例掌指关节全部存活。手功能评定：优22例，良7例，可3例，差2例；优良率为85％。X线片显示骨折愈合良好。结论 采用跖骨与掌骨成角固定及跖骨头下关节面45。截骨的方法，行第二跖趾关节游离移植重建掌指关节，该方法可行、有效。

Objective To introduce a new procedure of second toe metatarsophalangeal joint transfer to reconstruct metacarpophalangeal joint. Methods Cadaver dissection was done in 6 adult lower limbs under surgical microscope. Blood supply of the metatarsophalangeal joint and its range of motion was observed and measure. On the basis of the anatomic study, transfer of the metatarsophalangeal joint from the second toe was carried out in 34 cases to reconstruct the matacarpopalangeal joint. In cases of fist roetacarpophalangeal joint reconstruction, the metatarsal of the freed metatarsophalangeal joint was fixed to the first metacarpal at 30° to 45° angle. In eases of 2 to 5 metacarpophalangeal joint reconstruction, a 45° osteotomy under the metatarsal head was done. Wedge excision of the too thick planter plate was then carried out with preservation of the joint capsule and flexor tendon sheath before the metatarsal bone was re-approximated and fixed with Kirsehner wire. Results The 34 transplanted joints survived uneventfully. Passive range of motion of the metacarpophalangeal joints averaged 85°, ranging from 75°to 90°. Active range of motion averaged 80°, ranging from 70° to 90°. X-ray taken postoperatively revealed healed bones. Hand function was graded as excellent in 22 cases, good in 7 cases, fair in 3 eases, and poor in 2 cases. Conclusion Angular fixation of metatarsal and metacarpl bones and subarticular 45° oateotomy under the head of metatarsal bone in second metatarsophalangeal joint transfer can achieve good results in metacarpophalangeal joint reconstruction.