第5掌骨基底部腱-骨移植修复指基底部缺损

Tendon-bone graft of the fifth metacarpal base used for repair of the proximal phalangeal base defect

[目的]介绍第5掌骨基底部腱-骨移植修复近节指基底部复合缺损的手术技术和初步临床疗效。[方法]对6例近侧指骨基底部复合缺损患者行修复术。术前行X线检查,测量指基底部关节面缺损面积,根据骨折线设计截骨。于第5腕掌关节背侧作纵行切口,保护尺神经腕背支,按截骨设计切取第5掌骨基底部带部分尺侧腕伸肌腱的腱-骨移植,修整移植物,植于指骨基底缺损处,用克氏针或螺钉固定。[结果]所有患者均顺利完成手术,术中无血管、神经损伤等严重并发症,术后被修复关节稳定,无痛。术后影像显示受区骨折愈合时间为2.7~3.4个月,且供区第5腕掌关节稳定。术后随访6~12个月,末次随访时按中华医学会手外科学会手功能评定标准,临床结果4例优,2例良。[结论]第5掌骨基底部腱-骨移植能一期修复指骨基底部伸肌腱止点、肌腱、骨软骨缺损,是治疗指基底部复合组织缺损的有效方法。

[Objective]To introduce the surgical technique and preliminary clinical outcomes of the tendon-bone graft harvested from the fifth metacarpal base used for repair composed defect of the proximal phalangeal base.[Methods]A total of 6 patients received surgical repair for composed defect of proximal phalangeal base.As the X-ray examination was conducted to measure the area of the bone defect at the proximal phalangeal base preoperatively,osteotomy was designed on the fifth metacarpal base.A longitudinal incision was made on the dorsal side of the fifth metacarpocarpal joint with protection of the dorsal branch of the ulnar nerve,and then the tendon-bone graft with part of the extensor carpi ulnar tendon and the base of the fifth metacarpal was cut according to the osteotomy designed preoperatively.Fi⁃nally,the graft was trimmed to meet the phalangeal base defect,implanted on the receipt site and fixed with Kirschner wires or screws.[Re⁃sults]All patients had operation completed successfully without serious complications,such as vascular and nerve injury,whereas with the stable and painless repaired metacarpophalangeal joints after operation.The fracture healing of receipt site achieved from 2.7 to 3.4 months on the standard of X-ray,with a stable donor fifth metacarpocarpal joint.At the latest follow-up lasted for 6~12 months,the clinical out⁃comes were marked as excellent in 4 cases and good in 2 cases according to the hand function criteria of Hand Surgery Society of Chinese Medical Association.[Conclusion]The tendon-bone graft harvested from the fifth metacarpal base is effectively used to repair the com⁃posed osteochondral defect,involving the extension tendon insertion,on the proximal phalanx base.