不同术式的第二足趾关节移植治疗手部关节缺损的疗效

Treatment outcome of selective second toe joint transplantation for interphalangeal and metacarpophalangeal joint defect

目的 探讨不同术式的第二足趾关节移植治疗手指关节、掌指关节不同缺损的疗效。方法 在解剖学研究的基础上 ,1987年起临床应用吻合血管的四种术式修复手部关节缺损 :(1)跖趾全关节移植重建掌指关节 10例 ;(2 )带关节囊的近节趾骨基底部移植修复掌指关节远端缺损 4例 ;(3)趾间关节移植重建近指关节 5例 ;(4)带趾间关节的复合组织移植治疗带近指关节的复合组织缺损 4例。术后均进行早期系统的康复训练。结果 术后平均随访 2 .5年 ,按中华医学会手外科学会功能评定试用标准进行评定 ,优 10例 ,良 7例 ,中 4例 ,差 2例。带关节囊近节趾骨基底部移植的疗效最佳 ;趾间关节移植次之 ;而跖趾全关节移植、带趾间关节的复合组织移植疗效较差。

Objective To report the clinical results of selective second toe joint transplantation for treatment of interphalangeal and metacarpophalangeal joint defects. Methods Four types of second toe joint transplantation were conducted since 1987 to reconstruct finger joint defect: total metatarsophalangeal joint transplantation for metacarpophalangeal joint in 10 cases, transplantation of proximal phalanx base and its capsule for the distal half of metacarpophalangeal joint in 4 cases, transplantation of the interphalangeal joint from the second toe for proximal interphalangeal joint in 5 cases, and composite interphalangeal joint transplantation for complex defect of proximal interphalangeal joint in 4 cases. Early systematic rehabilitation was carried out after the operation. The mean follow up period was 2.5 years. All the cases were assessed according to the functional evaluation criteria formulated by Chinese Society for Surgery of the Hand. Results The transplants survived and healed well. 10 cases were graded excellent, 7 cases good, 4 cases fair and 2 cases poor. The result of transplantation of proximal phalanx base and its capsule was the best, followed by that of interphalangeal joint transplantation. The results of total metatarsophalangeal joint and composite interphalangeal joint transplantation were poor. Conclusions Selective second toe joint transplantation is a promising method for treatment of joint defects of the hand.