不同骨关节支架游离拇甲瓣修复或重建拇指

DIFFERENT BONE ARTICULAR FRAME AND FREE WRAPE AROUND FLAP TRANSFER FROM THE BIG TOE FOR RENOVATION OR RECONSTRUCTION OF THUMB

目的：探讨不同骨关节支架游离拇甲瓣修复或重建指最佳适应症。方法：对１９８７年３ 月至１９９８ 年１２ 月，行不同骨关节支架的游离拇甲瓣再造拇指４８ 例的长期随访疗效进行评定。骨关节支架有：①拇指脱套伤５ 例；②断离拇（ 手） 指骨关节支架２３ 例；③第二足趾带血管骨关节支架８ 例；④带未节拇趾骨关节支架９ 例；⑤髂骨条骨支架３ 例。结果：４８ 例重建拇指全部成活。拇指脱套伤组重建拇指外形及功能均佳；断离拇（ 手） 指骨关节支架组，指关节屈曲满意１８例，占７８ ％ ，末节指骨外露３ 例，占１５ ％ ，骨萎缩４ 例，占１７ ％ 。每二足趾带血管骨关节支架及带示节拇趾骨关节支架组，关节屈曲恢复较满意。髂骨条骨支架组，指关节屈曲不能，末节指骨外露１ 例，占３３ ％ 。结论：拇指脱套伤及断离拇（ 手） 指骨关节支架是拇甲瓣移植再造拇指最佳适应症。其他骨关节支架各有其对适应症。

Objective:To investigate the best indications for renovation or reconstruction of thumb based on different bone articular frame by means of free free wrap around flap transfer from the big toe.Methods: 48 cases ,who were performed renovation or reconstruction of thumbs based on different bone articular frame by means of frec wrap around flap transfer from the big toe from March 1987 to December 1998,have been followed up survey for long term ,and their curative effects have been evaluated too.There are some different bon articular frame:Pollical injury to strip off appearing as digitus cover(5 cases),Severed thumbs or fingers bone articular frame(23 cases),Second toe with blood vessel and bone articular frame(8 cases),Hhallew articular frame with last segment(9 cases),and iliac cord frame(3 cases).Results: The reconstructive thumds of 48 cases all are survival,The shape and function of the thumdswhose injury is to strip off appering as digitus cover are good after reconstruction.In severed thumbsor fingers group,the rlexion runction of 18 cases(78%) was gratirication,digitus bone of the end in 3 cases(15%) are exposed out ,bone atrophy of 4 cases (17%)are taken place.In second toe with blood vessel and articular frame,and hallex articular frame with last segment group,bending function of their joints are satisfactory.In iliac cord frame group,digitus bone of the end in 1 case(33%)is exposed out.Conclusions:Either pollical injury to strip off appearing as digitus cover or severed thumbs or fingersbone articular frame for replantation were best indications for thumb reconsttruction by wrap around flap transfer from the big toe,and severed thumb and finger.There are relative indications to other bone articular frame.