足趾组织移植拇手指再造105例126指功能随访观察

Functional Evaluation of 105 Cases of Thumb and Finger Reconstruction by Toe Tissue Transplantation

足趾组织移植再造拇手指重建手功能是目前较好的确定性手术，为对其远期效果有一客观的评定，我院邀请１０５例各种类型拇手指缺损再造病例返院随访，检查其外形、运动、感觉、关节活动度（ＴＡＭ）、日常生活活动（ＡＤＬ）、握力与捏力、手足后遗症状和继发畸形、恢复工作情况与病人满意程度等。其结果：再造拇指ＴＡＭ平均为７０．７°，７８．８％能与小指相对指。再造手指ＴＡＭ平均为１５３．２°，Ｂｏｙｃｅ距２～４．５ｃｍ。总的感觉在Ｓ３以上者为８６．５％，两点分辨觉４～１０ｍｍ间的Ｓ３＋与Ｓ４占６１．１％。握力与捏力在正常的２４％～９８．２％之间。ＡＤＬ能完成一半以上者占８２．４％。外形缺陷主要发生在以第二趾移植再造病例。供足存在后遗症状者占４２．２％。趾供趾比足趾供趾的足后遗症状发生率为高，分别为６２．５％和３８％。恢复原工作的占５０．５％，轻工作４６．７％，仅３例因原始伤重，术后仍不能工作。９８．１％病例对术后功能表示不同程度的满意，仅２例表示不满意。按中华手外科学会１９８９年制定手功能评定标准评定，Ｉ～Ｖ类病人的功能改善均较明显。按国际手外科学会联合会推荐的ＮａｋａｍｕｒａＴａｍａｉ法评定，总优良率为８１．５％。

econstruction of the thumb and finger by toe tissue transplantation is a well established procedure though long term final functional evaluation is few. A series of 105 cases of various kinds of thumb and finger defect patients were summoned for follow-up examination. The items include cosmetic effect,motion, sensibility, TAM, ADL, strength of grasp and pinch, residual symptoms or secondary deformity of the hand or donor foot, status of returning to work and patients'satisfaction etc.The results are: TAM of the reconstructed thumb is 70.7 ° in average,78.8% thumbs can opposite with little finger. TAM of the reconstructed fingers is 153.2 °,Boyce fingertip-crease distance is 2-4.5 cm. Sensation over S3 amounts to 86.5% of the digits. Two-point-discrimination within 10 mm is found in 61.1% digits. 82.4% hands can perform over half items of ADL. Some minor cosmetic defects are present in second toe transfer cases. Residual symptoms occur more often in great toe donor feet than the 2nd or 3rd toe donor feet in a ratio of 62.5% vs 38%. 50.5% of the patients have returned to their original jobs; 46.7% patients have changed to light work, while 3 severely damaged patients cannot resume work in spite of the reconstruction. 98.1% patients are satisfied with the toe-to-hand transfer though 2 patients are not. Functional evaluation with the standard set by Chinese Society of Hand Surgery in 1989, all the cases in Group I to Group V have obvious lessening of hand function impairment. The overall excellent/good rate of this series assessed with Nakamura Tamai criteria is 81.5%.