足第二趾近侧趾间关节移植再造拇手指关节

Reconstruction of finger joints using the proximal interphalangeal joint of the second toe

目的报道游离足第二趾近侧趾间关节移植再造拇手指关节临床疗效。方法对手指关节损伤49例54指，采用吻合血管的足第二趾近侧趾间关节移植修复，其中再造掌指关节21指、近侧指间关节28指、远侧指间关节5指。全关节移植38指，半关节移植16指，术后观察其临床疗效。结果移植关节49例54指全部成活。术后伤口均一期愈合。随访5～19个月，所有病例移植骨关节均愈合，临床愈合时间为4—8周，骨性愈合时间6～12周，移植关节均未出现退行性变，未出现骨不连及再骨折的现象。移植近侧指间关节屈曲活动度为35°～90°（平均65°）；移植掌指关节者屈曲活动度为30°～75°（平均45°）；移植远侧指间关节屈曲活动度为25°～65°（平均35°）。参照关节活动度TAM／TAF评定标准评定，属优者23指，良者25指，可者5指，差者3指，优良率84％。近侧指间关节移植者效果最佳，其次是掌指关节，远侧指间关节移植者最差。结论采用游离足第二趾近侧趾间关节移植修复拇手指关节缺损，功能恢复满意，可以较好的改善关节的功能。

Objective To assess the clinical efficacy of repair of thumb joints using the proximal iuterphalangeal joint of the second toe. Methods Proximal interphalangeal joint grafts of the second toe with vascular anastomosis were used to repair 54 fingers defects in 49 cases, including reconstruction of metacarpophalangeal joints in 21 fingers, proximal interphalangeal joints in 28 fingers and distal interphalangeal joints in 5 fingers, amounting to 38 fingers of entire joint transplantation and 16 fingers of semi-joint transplantation. An assessment was made for the clinical efficacy after the reconstruction. Results All 54 grafted joints in 49 cases survived. Primary postoperative healing was achieved. Followed-up from 6 to 19 months, all grafted joints clinically healed within 4 to 8 weeks. The bone healing time was 6 to 12 weeks. Degeneration of grafted joints was absent. Neither nonunion nor re-fracture was observed. The postoperative flexion activity range of proximal interphalangeal joints was 35°-90 °, averaged 65° ; the flexion range of metacarpophalangeal joints was 30°-75°, averaged 45° ; the flexion range of distal interphalangeal joints was 25°-65°, averaged 35°. According to the joint activity criteria TAM / TAF, there were 23 grafted fingers of excellence, 25 of satisfaction, 5 of average and 3 of poor recovery. Favorable grafts accounted for 84 percent. Best efficacy was evidenced in proximal interphalangeal joint grafts, followed by metacarpophalengeal ones,whereas distal interphalangeal transplantation provided poorer outcomes. Conclusion Repair of thumb joint defects using proximal interphalangeal joint grafts of the second toe free enables favorable functional recovery and satisfying improvement of joint activities.