手部骨缺损的修复与重建

Repair and reconstruction of bone defect in hand

目的研究因手指、掌骨缺损而导致手的外形和功能受限，通过显微外科技术重建的手术方法。方法采用自体游离或带血管髂骨与皮瓣组合、带血管跖趾关节或游离足趾与皮瓣组合等方法一期或分期再造残缺手或手指。用局部皮瓣游离皮瓣或串联皮瓣修复缺损的软组织，同时修复关节囊及肌腱缺损。根据重建类型，术后1～3周予以康复训练。结果本组19例，术后1例因严重感染导致手术失败并截指，2例部分皮肤创面予以二期覆盖，其余16例经8月～2．5年随访，按照中华医学会手外科学会断指再植功能评定试用标准评价结果，运动功能：优3例，良7例；感觉功能：优（S5）11例，良（S4）2例；外观评价：优5例，良6例。结论采用自体骨与皮瓣组合、自体足趾及关节移植与皮瓣组合等方法重建手与手指骨缺损，能最大程度地恢复手部外形及功能，降低手和手指残缺率。

Objective To study and solve the problem of dysfunction and cripple hand and defect of digital bone,by the methods of bone autografting malformation due to combinated with flaps to reconstruct the deficient hand and digits.Methods Vascularized iliac bone or metatarsophalangeal joints （MPJ） or toes transplantation incorporated with flaps were used to reconstruct the defected bone in palm or fingers. Combined with tendon defect in such cases should be repaired or restituted by tendon autografting in one stage or by stages.Results Total 16 cases were treated by the methods metioned above. Except 1 of 16 was failure resulted in severe infection, the others were reconstructed successfully. 13 of 16 were followed up 8-30 months, the evalution of the group from motion,sensation and appearance showed that the fine rate of motion was 53.8 percent, the rate of appearance and sensation were both 69 percent. Conclusion Vascularized iliac bone or metatarsophalangeal joints （MPJ）or toes transplantation incorporated with flaps were available to reconstruct the defected bone in palm or fingers.We could reduce disability effectively while obtain a satisfactory appearance and proper functions by those methods.