中华显微外科杂志
中華顯微外科雜誌
중화현미외과잡지
Chinese Journal of Microsurgery
2012年
1期
10-12
,共3页
丁小珩%方光荣%张宏勋%刘育杰%屈志刚%姜凯%焦鸿生%潘达德
丁小珩%方光榮%張宏勛%劉育傑%屈誌剛%薑凱%焦鴻生%潘達德
정소형%방광영%장굉훈%류육걸%굴지강%강개%초홍생%반체덕
跖趾关节%再造%跖骨%显微外科%截骨
蹠趾關節%再造%蹠骨%顯微外科%截骨
척지관절%재조%척골%현미외과%절골
Metacarpophalangeal joint%Reconstruction%Metatarsals%Microsurgery%Osteotomy
目的 探讨带跖趾关节的第二趾移植再造拇手指过程中,利用跖骨头软骨面下选择性截骨来改善跖趾关节屈曲方向的手术方法和临床疗效. 方法 对21例21指带跖趾关节的第二趾移植再造拇、手指病例,术中在第二跖骨头底部关节囊近侧做截骨口,距跖趾关节面5.0 mm处进入跖骨,弧形截除松质骨,使跖趾关节可以屈曲到90°为止,纵贯或交叉克氏针固定关节,再按常规的再造方法重建动力、神经及血液循环. 结果 本组所有再造指均成活.随访时间6～24个月,其中6例得到长期随访(12 ～ 24个月).再造指的掌指关节被动活动范围65°～85°,平均75°.主动活动范围45°～80°,平均65°.X线片复查显示骨质愈合良好,无关节退性行变表现. 结论 在带跖趾关节的第二趾移植再造拇、手指过程中,采用跖骨头软骨面下选择性截骨的方法能明显增加再造掌指关节主、被动屈伸活动度,是提高再造指掌指关节活动度的较佳方法.
目的 探討帶蹠趾關節的第二趾移植再造拇手指過程中,利用蹠骨頭軟骨麵下選擇性截骨來改善蹠趾關節屈麯方嚮的手術方法和臨床療效. 方法 對21例21指帶蹠趾關節的第二趾移植再造拇、手指病例,術中在第二蹠骨頭底部關節囊近側做截骨口,距蹠趾關節麵5.0 mm處進入蹠骨,弧形截除鬆質骨,使蹠趾關節可以屈麯到90°為止,縱貫或交扠剋氏針固定關節,再按常規的再造方法重建動力、神經及血液循環. 結果 本組所有再造指均成活.隨訪時間6～24箇月,其中6例得到長期隨訪(12 ～ 24箇月).再造指的掌指關節被動活動範圍65°～85°,平均75°.主動活動範圍45°～80°,平均65°.X線片複查顯示骨質愈閤良好,無關節退性行變錶現. 結論 在帶蹠趾關節的第二趾移植再造拇、手指過程中,採用蹠骨頭軟骨麵下選擇性截骨的方法能明顯增加再造掌指關節主、被動屈伸活動度,是提高再造指掌指關節活動度的較佳方法.
목적 탐토대척지관절적제이지이식재조무수지과정중,이용척골두연골면하선택성절골래개선척지관절굴곡방향적수술방법화림상료효. 방법 대21례21지대척지관절적제이지이식재조무、수지병례,술중재제이척골두저부관절낭근측주절골구,거척지관절면5.0 mm처진입척골,호형절제송질골,사척지관절가이굴곡도90°위지,종관혹교차극씨침고정관절,재안상규적재조방법중건동력、신경급혈액순배. 결과 본조소유재조지균성활.수방시간6～24개월,기중6례득도장기수방(12 ～ 24개월).재조지적장지관절피동활동범위65°～85°,평균75°.주동활동범위45°～80°,평균65°.X선편복사현시골질유합량호,무관절퇴성행변표현. 결론 재대척지관절적제이지이식재조무、수지과정중,채용척골두연골면하선택성절골적방법능명현증가재조장지관절주、피동굴신활동도,시제고재조지장지관절활동도적교가방법.
Objective To investigate the technique and clinical results of curved osteotomy under the metatarsal head's cartilage for improving reconstructed metacarpophalangeal joint function of fingers with second toe transplantation. Methods There were total 21 cases with 21 digits. During second toe transplantation with the metatarsophalangeal joint, the bottom of the second metatarsal head was incised. Then a curved osteotomy were carried out on about 5.0 mm under the metatarsal head's cartilage until the passive range of motion could be 90°.Longitudinal or cross-Kirschner wires were used to fix the joint.Finally,the conventional methods were used to reconstruct the blood supply, movement and nerves. Results All 21 digits of the 21 cases survived uneventfully.The follow-up time was ranged from 6 to 24 months.Their average passive range of motion of the reconstructed metacarpophalangeal joint was 75°,ranging from 65° to 85°.The average active range of motion was 65°, ranging from 45° to 80°. Postoperative X-ray revealed fracture healed well without joint degeneration. Conclusion Curved osteotomy under the metatarsal head's cartilage is an effective way to improve active and passive activities function of the reconstructed metacarpophalangeal joint with second toe transplantation.
