断指远位寄存二期再造的实验研究和临床应用

The experimental research and clinical application of the thumb/finger reconstruction in the secondary stage by means of conserving the severed thumb in the distant position

目的研究兔趾骨移植术后不同时间血循环的建立及组织学改变,以寻找最佳再植时间,为临床应用自体移植骨修复重建器官提供实验依据,并探索离断指远位寄存二期再造的方法。方法建立模型,使用免疫组化等方法观察新生血管情况,并观察移植骨吸收情况。将断指植入皮瓣下或皮管内,待其周围形成新的血管网后,切下行局部转移,二期再造。结果①移植骨术后6周血管生成较多,均成活。②9例皮瓣或皮管均一期愈合,再造手指成活,随访手指外形、功能恢复良好。结论①移植骨植入6周左右新生血管成熟,可连同皮瓣切取移植;移植骨术后均有不同程度吸收。②离断指远位寄存二期再造,可使手指有较好外形及功能,避免了离断指的废弃,为手指再造提供新的方法。

Objective To study the blood circulation construction and the histological structure change of bone grafts at the different time after bone transplantation,and to explore the best excisional time of bone transplantation to provide the experimental theory foudation for clinical application of thumb/finger reconstruction, and to explore the application of thumb reconstruction on the clinical patients. Methods We set the model with rabbit former claws. By using of immunohistochemical staining and nucle- ar medicine,the circumstances of new vessels had been observed to explore the best excisional time of cuhure thumbs/fingers and observe the absorbing of bone grafts. The thumbs/fingers without possibility of reimplant one implanted in skin flaps or skin tubes after about 6 weeks, the new vessels had creeped around bone grafts , then sliced all and reconstructhem with micrurgy. Results （1）All of culture thumbs/fingers survived with a few new vessels after 6 weeks ;（2）The 9 skin flap/tube were in primary healing af- ter operation. The reconstructed thumbs survived. After follow up,thumbs/flnger were with good function and appearance. Conclusion （1）New vessels get matured on 6w after transplantation and bone grafts can be used to skin flap transplantation. All bone grafts have been absorbted at different level after transplantation. （3）It is a quite ideal operation method that thumbs/fingers is reconstructed in the secondary stage by conserving the severed thumb/finger in the distant position.