不带血管趾骨移植修复婴幼儿手指发育不良的临床应用

Clinical application of nonvascularized toe phalangeal transfer for treatment of congenital symbrachydactyly in infants and children

目的探讨采用不带血管的游离趾骨移植治疗婴幼儿先天性手指发育不良的效果,并总结手术治疗体会。方法自2016年5月至2019年12月,我们对8例(13指)先天性手指发育不良患儿,采用不带血管的游离中节趾骨移植于患指软组织内,取髂骨移植于趾骨供区。供区及受区均用克氏针内固定。术后随访游离移植趾骨的存活情况、骨骺发育情况、手指生长长度。结果术后8例(13指)移植趾骨全部存活,随访时间为12个月至4年,平均24个月,骨骺均未发生早闭。其中1例足趾供区的移植髂骨块发生骨吸收。患指平均延长6 mm(4~15 mm)。所有患指外观明显改善,功能部分恢复。结论不带血管的游离趾骨移植是治疗婴幼儿先天性手指发育不良的可选择的方法。

Objective To investigate the clinical efficacy of nonvascularized toe phalangeal transfer for treatment of congenital symbrachydactyly in infants and children and summarize the experience of surgical treatment.Methods From May 2016 to December 2019,8 cases(13 fingers)with congenital symbrachydactyly were treated by nonvascularized toe phalangeal transfer into the soft tissue of affected fingers.The iliac bone was transplanted into the donor area of phalangeal bone.Both donor and recipient areas were fixed with Kirschner wire.The survival,epiphyseal development and finger growth length of free transplanted phalanges were followed up.Results The follow-up time was 12 months to 4 years,with an average of 24 months.All the 8 cases(13 fingers)survived after operation.There was no premature closure of epiphysis.Bone resorption occurred in one case of iliac bone graft in the donor area of toe.The average extension of the affected finger was 6 mm(range,4 to 15 mm).The appearance of all the affected fingers was significantly improved and the function was partially restored.Conclusion The nonvascularized toe phalangeal transfer is an optional method for the treatment of symbrachydactyly in infants and children.