小指展肌移位并跖趾关节背侧关节囊切开改善再造拇指功能

The shifting abductor muscle of little finger and metatarsophalangeal joint dorsal articular capsule inci-sion to improve the function of reconstructed thumb

目的探讨应用小指展肌移位并跖趾关节背侧关节囊切开改善再造拇指的外形与功能的临床效果。方法自2007年8月至2012年5月，对12例拇指Ⅳ°、Ⅴ°缺损患者，采用携带跖趾关节的第二足趾游离移植再造拇指，术中采用小指展肌移位重建拇对掌功能，并通过跖趾关节背侧关节囊切开，应用小指展肌、趾短伸肌调节跖趾关节张力，改善再造拇指外形与功能。结果12指全部成活。术后随访6～24个月，再造拇指外形及功能明显改善，按中华医学会手外科学会上肢部分功能评定试用标准评定：优9例，良3例。结论应用小指展肌移位能重建再造拇指的对掌功能，并结合跖趾关节背侧关节囊切开，调节关节张力，能改善再造拇指外形，手术疗效满意。

Objective To explore the effect of shifting the little finger abductor muscle and cutting open the metatarsophalangeal joint dorsal articular capsule to improve the appearance and function of reconstructed thumb. Methods From August 2007 to May 2012, twelve cases of Ⅳ°or Ⅴ°~defect of thumb were repaired by free transplantation of the second toes with metatarsophalangeal joint. During operation, using the abductor muscle of little finger to reconstruct palmar opposition function, cutting open the joint capsule of metatarsopha-langeal joint, adjusting the tension of the joint by the little finger abductor muscle and toe short extensor mus-cles, which were used to improve the appearance and function of reconstructed thumb. Results Twelve re- constructed thumbs all survived. Followed up from 6 to 24 months, the appearance and function were improved obviously. According to the evaluation trial standards, nine cases were optimal and 3 cases were good. Con- clusion The shift of the little finger abductor muscle could reconstruct palmar opposition function, combined with metatarsophalangeal joint dorsal articular capsule incision and adjusting joint tension, could improve the ap- pearance and function of reconstructed thumb. The effect of operation was satisfied.