携带微型皮瓣的第二趾近趾间关节移植修复手指近指间关节缺损

Repair of proximal interphalangeal joint （ finger ） defects using the second toe proximal interphalangeal joint with sldn flaps

目的探讨采用携带微型皮瓣的游离第二趾近趾间关节移植修复手指近指间关节缺损的临床疗效。方法对23例28指近指间关节缺损的患者，采用吻合血管的第二趾近趾间关节游离移植，其中全关节移植18指，半关节移植10指。结果23例28指微型皮瓣全部存活，术后伤口均Ⅰ期愈合，无感染及骨髓炎发生。所有移植骨关节均愈合，临床愈合时间为4～8周，骨性愈合时间为6-10周；术后随访时间为5～16个月，平均9个月，移植关节均未出现退行性改变。1例2指半关节移植者术后移植关节向掌侧脱位，经手术再次矫形获得成功。移植近指间关节屈曲活动度为35°-90°，平均65°。参照关节活动度TAM／TAF评定标准评定：优10指，良14指，可2指，差2指；优良率为86％。结论采用携带微型皮瓣的游离第二趾近趾间关节移植修复手指近指间关节缺损，功能恢复满意，关节活动可满足日常生活的需要，能很好地改善关节的功能。

Objective To discuss the clinical efficacy of repairing proximal interphalangeal （PIP） joint （finger） defects by transferring the second toe PIP joint with mini-flaps. Methods PIP joint transfer from the second toe with vascular anastomosis was used to repair 28 PIP joint （finger） defects in 23 cases, among which 18 were total joint transfer and 10 were semi-joint transfer. Results All 28 transplants in 23 eases survived. Primary postoperative healing was achieved, without the occurrence of infection and osteomyelitis. All grafted joints clinically healed within 4 to 8 weeks. The bone healing time was 6 to 10 weeks. The duration of postoperative follow up was 5 to 16 months with an average of 9 months. Degeneration of grafted joints was absent. Palmar joint dislocation was found in one case with semi-joint transfer involving two and a half fingers, which was successfully corrected by arthroplasty. The postoperative range of motion if the transferred PIP joint was 35° to 90°, with an average of 65°. According to joint movement TAM / TAF criteria, outcomes of this series were graded as excellent in 10 grafted fingers, satisfactory in 14 fingers, average in 2 fingers and poor in 2 fingers. Overall excellent and good rate was 86%. Conclusion Repair of PIP joint （finger） defects using PIP joint transfer from the second toe enables favorable functional recovery and joint movement that meets daily needs, providing satisfying functional improvement of the joints.