调节血管前后负荷在小关节移植中的应用

Application of regulallng pre- and post-load of the blood vessel in small joint transplantation

目的探讨调节血管前后负荷在手部小关节移植中的临床应用。方法对6例手部小关节缺损患者，4例掌指关节缺损，2例近指间关节缺损，分别采用第二足趾的跖趾关节和近趾间关节游离移植修复，术中将传统的穿支血管端-端吻合改良为侧支吻合、端-侧吻合、嵌顿吻合三种方式，通过调节动脉的灌注量和静脉的回流量来平衡游离组织内的压力。结果6例小关节游离移植全部存活。3例术后3个月行肌腱松解术，随访3～16个月，平均6个月，按中华医学会手外科学会上肢部分功能评定试用标准：移植的掌指关节屈曲75°-85°，背伸-10°～0°，4．5分；指间关节屈曲65°～75°，背伸-15°～0°，3．1分；手指外观满意，对指、对掌功能恢复良好，足趾行走功能无明显影响。结论调节血管前后负荷能提高手部小关节游离移植的成活率。

Objective To explore the clinical application of regulating the pre- and post-load of the blood vessel in small joint transplantation. Methods Four cases of metacarpophalangeal joint defects and 2 cases of proximal interphalangeal joint defects were treated with free transplantation of the second toe metatarsophalangeal joint and proximal interphalangeal joint, respectively. The conventional end-to-end anastomosis of perforators was modified to collateral anastomosis, end-to-side anastomosis, and inset anastomosis. The pressure within the free tissue was balanced by the regulation of the arterial perfusion volume and venous return flow. Results All 6 transplants of small joint free transplantation survived. Tenolysis was done in 3 cases 3 months postoperatively. All the cases were follow-up for 3 to 16 months, the average being 6 months. Range of motion of the metacarpophalangeal joint was 75° to 85°of flexion and - 10° to 0° of dorsiflexion： 4.5 points based on the upper limb functional assessment criteria issued by the Chinese Hand Surgery Society. Range of motion of the interphalangeal joint was 65° to 75° of flexion and - 15°to 0° of dorsiflexion： 3.1 points. The appearance of the fingers was satisfactory, while the thumb opposition function was good. Conclusion Regulating the pre- and post-load of the blood vessel can improve the survival rate of small joint free transplantation.