足趾移植术后足部并发症的临床研究

Clinical study on postoperative complications of foot after toe transplantation

目的：比较四种不同方法所致足趾移植术后足部远期临床并发症，评价各术式的优缺点，提出改进的方法。方法选取2006年以来采用不同术式进行足趾移植再造手指的患者为研究对象，共70例，分四组，即第2足趾移植组、甲瓣（带部分末节趾骨）移植组、第2趾＋甲瓣（带部分末节趾骨）移植组、带跖趾关节的第2足趾移植组，术后两年以上。随访项目：⑴快速行走一天后足部有无疼痛及程度；⑵足外观满意程度；⑶有无足底胼胝或组织增厚；⑷正常行走时步态（有无跛行）变化；⑸中等体力劳动耐受情况。对上述不同术式术后产生的疼痛及运动障碍并发症给予评分并进行比较分析。结果足趾移植后造成的各类足趾缺损均会对足功能产生不同影响，第2趾移植、甲瓣（带部分末节趾骨）移植对患足影响程度较小；甲瓣（带部分末节趾骨）和第2趾同时移植影响程度较大；带跖趾关节的第2足趾移植对患足的影响最重，疼痛及运动障碍并发症评分最高。结论足趾缺损数量越多，长度越长，临床并发症也越严重，带跖趾关节的第2足趾移植再造手指术应慎用。

Objective To compare long term complications of four kinds of toe transplant ation, to evaluate the merits and demerits of different operation and to propose the improved method. Methods We study cases based on different operation of rebuilding finger and thumb from 2006, dividing into four groups ： the group of the second toe transplantation, the group of the thumb-toe flap transplantation（with the end-part of phalanges ）, the group of the toe-thumb flap with metatarsophalangeal joint, the group of the second toe transplantation with metatarsophalangeal joint. We followed up the five items of the complication： the pain and pain level after one-day rapid walking on the foot; satisfaction degree with appearance of foot; have or not callosity or issue became thickened; the change of gait during normal walking （ Lameness or not ）; the degree of tolerance with medium manual labor. The painful and motor changes were measured and compared in different operational manner. Results All kinds of the operation influence foot function. The thumb and toe flap transplantation have larger impact on it, the second toe transplantation with metatarsophalangeal joint has the largest impact on it. The pain and dysfunction complication got maximum. Conclusion The more and the longer of toes defect, the stronger the influence of the plane stress distribution on the forefoot, the more serious of complication. So it must be cautiously used for the operation of the second toe transplantation with metatarsophalangeal joint rebuilding finger.