数字化技术辅助多手指缺损再造的应用价值

Application value of digital technique to assist in the reconstruction of multiple fingers defect

目的 探讨在数字化技术辅助下进行足趾移植多手指再造的临床意义. 方法 对多个手指不同程度缺损5例患者,术前使用64排螺旋CT进行双足及双手扫描,通过计算机软件建立三维图像模型,明确供、受区动、静脉血管走向、分型及受区缺损面积、形状等参数,设计与具体病例手指缺损的数量、每个手指缺损的长度以及受区皮肤缺损的面积、形状相匹配的个性化手术方案.实施同侧（母）甲瓣联合第2足趾趾骨、对侧第2足趾联合足背皮瓣移植分别再造拇、示指2指1例;对侧第2足趾与同侧第2、3足趾分别联合带跖趾关节的足背皮瓣移植分别再造拇、示、中指3指l例以及示、中、环指6指2例;双侧第2、3足趾联合足背皮瓣,对侧第2、3足趾带跖趾关节、同侧第2足趾串联髂骨块移植分别再造中、示、环、小指4指1例,5例移植再造15指. 结果 再造15指全部成活,经6个月～1年随访,再造手指外观接近正常,保护性感觉、针刺痛觉及实体感觉恢复良好,两点辨别觉6 ～12 mm,对捏,对掌功能恢复,握力达健侧50％～70％,临床效果满意. 结论 数字化技术能为术前制定个性化精确化的多手指再造手术方案,有利于降低手术风险,提高多指再造成活率,具有临床实用意义.

Objective To investigate the clinical significance of the reconstruction surgery using the toes to repair multiple fingers defect with the help of the digital technology.Methods For the 5 patients with multiple fingers defect in the different degrees,the feet and hands were scaned by the 64 splice helical CT before operation;to establish three-dimensional image model by using the computer software.It helped us to know the parameters of the move direction and classification of the arteries and veins both donor and recipient site ; and the defect area and shape in the recipient site,etc.It was helpful for designing personalized surgical scheme that could match with the number of finger defect requirement;the length of each finger defect and the defect area and shape in the recipient site of the specific case.Out of five cases,1 case involved the recontrustion of the thumb and index finger.We used the composite tissue flap of both the first toe＆#39;s flap and the second toe＆#39;s phalanx on the corresponding side of the fingers defect area to reconstruct the thumb.Both the second toe and dorsalis pedis flap on the opposite side of the fingers defect area were used to reconstruct the index finger.Another case involved the recontrustion of the thumb,index finger and middle finger.We used the second toe along with the dorsalis pedis flap with the plantar toe joint on the opposite side of the fingers defect area to repair the damaged thumb.Both the second and third toe along with the dorsalis pedis flap with plantar toe joint on the corresponding side of the fingers defect area were used to reconstruct the index finger and middle finger.The other 2 cases involved the recontrustion of the index fingers,middle fingers and ring fingers of two patients.We used the second toe along with the dorsalis pedis flap with the plantar toe joint on the opposite side of the fingers defect area to repair the damaged index finger.Both the second and third toe along with the dorsalis pedis flap with plantar toe joint on the corresponding side of the fingers defect area were used to reconstruct the middle finger and ring finger.The last 1 case involved the recontrustion of the index finger,middle finger,ring finger and little finger.We used both the second and third toes on the corresponding side of the fingers defect area along with iliac blocks to reconstruct the ring finger and little finger.Both the second and third toes along with dorsalis pedis flap with plantar toe joint on the opposite side of the fingers defect area were used to reconstruct the middle finger and index finger.A total of 15 fingers were reconstructed in the 5 cases.Results With the help of digital technology,all 15 reconstructed fingers survived successfully.With 6-12 months＆#39; followed-up,the appearance of the reconstructed fingers was very closed to the normal fingers.The protective sensation,acmesthesia and stereognosis of the reconstructed fingers showed good recoveries.The two-point discrimination was 6-12 mm.The pinch and opponens functions of the reconstructed fingers were restored.The grip strength of the reconstructed fingers was close to 50%-70% of the contralateral fingers.The reconstructed fingers obtained good clinical effect.Conclusion The digital technology can help us formulate the operation scheme of personalized and accurate reconstruction of multiple fingers before the operation.It was helpful to reduce the operation risk and improve the survival rate of multiple fingers reconstruction.It has very good practical and clinical significance.