CAJ | 학술논문

目的随访第二足趾游离移植再造拇指的功能,探讨足趾移植再造拇指指趾骨固定及掌指关节重建术两种方法的疗效.方法对2006年6月-2008年6月,行第二足趾游离移植再造拇指16例的疗效进行评定.A组指趾骨固定方法:克氏针贯穿固定移植趾骨与近节指骨6例,术后4-6周后拔克氏针,开始功能锻炼.B组关节囊重建方法:克氏针贯穿固定移植趾骨与第一掌骨10例,术后3周拔克氏针,开始功能锻炼.术后随访3～30个月.结果 A组术后移植指肌腱粘连均不能屈指,占100%;B组中术后移植指肌腱粘连屈指不能4例,占40%.经再次行肌腱松解术后,再造拇指屈曲功能明显改善:A组4例,有效率66.7%;B组3例,有效率75.0%;总有效率81.3%.结论针对拇指Ⅱ类A区与B区之间缺损去除近节基底和Ⅱ类B区缺损,足趾游离移植再造拇指掌指关节囊重建术有利于术后早期锻炼,疗效优于指趾固定术.
목적 수방제이족지유리이식재조무지적공능,탐토족지이식재조무지지지골고정급장지관절중건술량충방법적료효.방법 대2006년6월-2008년6월,행제이족지유리이식재조무지16례적료효진행평정.A조지지골고정방법:극씨침관천고정이식지골여근절지골6례,술후4-6주후발극씨침,개시공능단련.B조관절낭중건방법:극씨침관천고정이식지골여제일장골10례,술후3주발극씨침,개시공능단련.술후수방3～30개월.결과 A조술후이식지기건점련균불능굴지,점100%;B조중술후이식지기건점련굴지불능4례,점40%.경재차행기건송해술후,재조무지굴곡공능명현개선:A조4례,유효솔66.7%;B조3례,유효솔75.0%;총유효솔81.3%.결론 침대무지Ⅱ류A구여B구지간결손거제근절기저화Ⅱ류B구결손,족지유리이식재조무지장지관절낭중건술유리우술후조기단련,료효우우지지고정술.
Objective To evaluate the functions of the fingers reconstructed by second toe transplantation and compare the results of two different procedures of transplant fixation: phalangeal fixation or metacarpophalangeal capsuloplasty. Methods Sixteen patients who underwent second toe transplantation for thumb reconstruction in the period from June 2006 to June 2008 were followed and evaluated. All the patients sustained posttraumatic class Ⅱ defect of the thumb. In group A the transferred toe was fixed by phalangeal fixation. The phalanx of the transferred toe was fixed to the remaining part of proximal phalanx of the thumb by a transarticular Kirschner wire. There were 6 cases in this group.The K-wire was removed 4 to 6 weeks postoperatively when rehabilitation started. In group B the transferred toe was fixed to the first metacarpus by a transarticular Kirschner wire and suturing the joint capsule. There were 10 cases in this group. The K-wire was withdrawn 3 weeks after the operation when rehabilitation was initiated. All patients were followed for 3 to 30 months. Results Tendon adhesion which led to impaired flexion of the reconstructed fingers occurred in all cases of group A, constituting 100%. There were 4 cases of postoperative tendon adhesion in group B, accounting for 40%. After tenolysis, the flexion function was improved in 4 cases of group A and 3 cases of group B, constituting 66.7% and 75.0% respectively. The overall effective rate was 81.3% . Conclusion Class II thumb defect between zone A and zone B converted by removing proximal phalanx base and class Ⅱ thumb defect at zone B can be reconstructed with toe transfer by capsuloplasty at the metacarpophalangeal joint. This procedure leads to better results than phalangeal fixation because it facilitates early postoperative rehabilitation and reduces tendon adhesion.