数字化技术辅助下足趾组织移植修复拇指和手指软组织缺损12例

Application of digital technique to assist in the reconstruction of thumb and fingers defect

目的探讨数字化技术辅助下进行足趾组织重建拇、手指软组织缺损的临床应用。方法自2012年6月至2017年5月,对12例17指拇、手指软组织缺损患者在数字化技术辅助下行足趾组织移植修复。手术前行同侧或对侧足3D-CTA,进一步通过计算机软件重建三维数字化模型,了解供区血管走向、分型等参数,设计与手指缺损长度及软组织缺损的形状、面积相适应的个性化重建方案。结果12例移植重建的17指全部成活,随访6个月~1年,重建手指外观近似正常,两点辨别觉达6~10mm,依照中华医学会手外科学会上肢部分功能评定试用标准评价:优9指,良6指,可1指,差l指。结论数字化技术能为拇、手指软组织缺损设计精确化、个性化的重建方案提供依据,有效的减少了手术风险,成活率提高,临床意义大。

ObjectiveTo investigate the clinical significance of the reconstruction surgery using the toes to repair thumb and fingers defect with the help of the digital technology. MethodsBetween June, 2012 and May, 2017, 17 partial thumb and finger defects in 12 cases received 3D-CTA assisted finger reconstruction surgeries in using the toe. Preoperative ipsilateral foot 3D-CTA were conducted and the 3D digital models were analyzed. It helped to know the parameters of the move direction and classification of the arteries and veins, etc. It was helpful for designing personalized surgical scheme that could match with the length of each finger defect and the defect area and shape in the recipient site of the specific case. ResultsAll 17 toe-to-hand transplants in 12 cases survived. With 6-12 month's followed-up, the appearance of the reconstructed fingers was very closed to the normal fingers. The two-point discrimination was 6-10 mm. According to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 9 digits, good in 6 digits, fair in 1 digit and poor in l digit. ConclusionThe digital technology can help to formulate the operation scheme of personalized and accurate reconstruction of thumb and fingers before the operation. It was helpful to reduce the operation risk and improve the survival rate of fingers reconstruction. It has very good practical and clinical significance.