利用一个足趾游离移植同时修复两个手指组织缺损

目的 探讨利用一个足趾游离移植同时修复两个手指组织缺损的临床效果.方法 采用同一个足趾两个部分游离移植,同时修复两个手指关节复合组织或手指缺损,临床应用4例8指,其中2例用第二足趾的末节再造示指的末节或指尖,同时用第二足趾的近趾间关节组织块修复中指的近指间关节组织缺损;1例用第二足趾的远趾间关节和近趾间关节组织块同时再造示、中指的近指间关节:1例用第二足趾的近趾间关节和跖趾关节组织块同时再造示、中指的掌指关节.结果 术后再造组织全部成活,随访2～46个月,手部的功能外观满意,关节活动良好,无疼痛,按中华医学会手外科学会拇手指再造功能评定试用标准评定,有2指为优,5指为良,1指为可.结论 对于同时合并两个手指的末节、指间关节或掌指关节缺损的病例,本手术是一种较好的修复方法.     

利用一个足趾游离移植同时修复两个手指组织缺损

目的 探讨利用一个足趾游离移植同时修复两个手指组织缺损的临床效果.方法 采用同一个足趾两个部分游离移植,同时修复两个手指关节复合组织或手指缺损,临床应用4例8指,其中2例用第二足趾的末节再造示指的末节或指尖,同时用第二足趾的近趾间关节组织块修复中指的近指间关节组织缺损;1例用第二足趾的远趾间关节和近趾间关节组织块同时再造示、中指的近指间关节:1例用第二足趾的近趾间关节和跖趾关节组织块同时再造示、中指的掌指关节.结果 术后再造组织全部成活,随访2～46个月,手部的功能外观满意,关节活动良好,无疼痛,按中华医学会手外科学会拇手指再造功能评定试用标准评定,有2指为优,5指为良,1指为可.结论 对于同时合并两个手指的末节、指间关节或掌指关节缺损的病例,本手术是一种较好的修复方法.     

利用一个足趾游离移植同时修复两个手指组织缺损

目的 探讨利用一个足趾游离移植同时修复两个手指组织缺损的临床效果.方法 采用同一个足趾两个部分游离移植,同时修复两个手指关节复合组织或手指缺损,临床应用4例8指,其中2例用第二足趾的末节再造示指的末节或指尖,同时用第二足趾的近趾间关节组织块修复中指的近指间关节组织缺损;1例用第二足趾的远趾间关节和近趾间关节组织块同时再造示、中指的近指间关节:1例用第二足趾的近趾间关节和跖趾关节组织块同时再造示、中指的掌指关节.结果 术后再造组织全部成活,随访2～46个月,手部的功能外观满意,关节活动良好,无疼痛,按中华医学会手外科学会拇手指再造功能评定试用标准评定,有2指为优,5指为良,1指为可.结论 对于同时合并两个手指的末节、指间关节或掌指关节缺损的病例,本手术是一种较好的修复方法.

Abstract：

Objective To investigate the outcome of the finger reconstruction using one toe transfer to repair the tissue defects of two fingers at the same time. Methods Two fingers joint tissue missing and finger defect of 8 fingers in 4 cases were reconstructed with dissociative transplants harvested from two parts of the same toe at the same time.Using the paratelum of the second toes reconstructed the indicis paratelum or finger tip,and using the proximal interphalangeal joint of the second toes repaired the proximal interphalangeal joint's tissue defects of the middle finger at the same time in 2 cases.Using the distal interphalangeal joint and the proximal interphalangeal joint of one second toe reconstructed the proximal interpha langeal joints of the index finger and the middle finger in 1 case.Using the proximal interphalangeal joint and the metatarsophalangeal joint of one second toe reconstructed the metacarpophalangeal joints of the index finger and the middle finger in 1 case. Results All the transplants survived.The patients were followed-up from 2 months to 46 months postoperatively.The function and shape of 2 resconstruction fingers were excellent as assessed with Criterion on Functional Evaluation on Finger Reconstruction issued by Chinese Society of Hand Surgery.Five resconstruction fingers were good.One resconstruction finger was fire. Conclusion For some appropriate cases with the tissue defects of 2 fingers such as the finger's paratelum,the interphalangeal joint or the metacarpophalangeal joint,this operated technique was a good method.     

Anatomic basis of dorsal finger skin cover

This study describes the anatomy of the dorsal cutaneous vascular system of 180 digits (36 thumbs, index, middle, ring, and little fingers) from 18 pairs of fresh human cadaver hands. The aim of this paper is to incorporate the anatomic data into the current way of designing the homodigital adipofascial turnover flap for cutaneous coverage of the dorsum of the finger. We have carried out an anatomic study in preserved cadaver hands to define the distance between the joint and the origin of the dorsal cutaneous branches of the proper palmar digital artery in the proximal and middle phalanx of the long fingers and for the thumb to metacarpal and interphalangeal joint. All branches of the proper digital artery that ran to the dorsal skin were then identified, and their diameters and the distances of their origins from the proximal interphalangeal joint were measured. We showed that 2 constant branches in the proximal and middle phalanx from each proper digital artery have consistent sites of origin at predictable distances from the proximal interphalangeal joint for the long fingers and the metacarpal and interphalangeal joint for the thumb. The flap survival was excellent, and no donor site complications were observed. We showed that these branches have consistent sites of origin at predictable distances from the proximal interphalangeal joint. The adipofascial turnover arterial flap has appeared as an excellent alternative to achieve early coverage of cutaneous wounds at the dorsal aspect of the fingers.     

先天性手部关节挛缩症的治疗

目的 探讨先天性多发性手部关节挛缩症手术方法的选择.方法 对8例(23指)先天性手部关节挛缩症的患儿,分别采用关节囊掌板松解、指浅屈肌腱止点切断、深浅肌腱交替术、皮片移植术等方法,术中以挛缩的关节能被动伸直为标准,采用克氏针内固定和术后石膏外固定相结合的方法进行治疗.结果 术后23指伤口均I期愈合.随访时间为12～25个月,关节功能及手指外形良好,除1例(4指)出现肌腱轻度粘连外,7例中14指(累及掌指关节1指,近指间关节13指)主、被动活动达到正常.其余手指背伸损害值V伸=5°～10°.结论 手部先天性多发性关节挛缩症根据组织的挛缩程度,通过上述方法可获得良好的治疗效果.     

The mechanism of the intrinsic-minus finger: a biomechanical study

To demonstrate in the cadaver model that the sequence of extension of the flexed metacarpophalangeal and proximal interphalangeal joints of the intrinsic-minus finger can be explained on the basis of moment ratios about these joints, the engineering concept of free body analysis was applied. Intrinsic-minus fingers, i.e., fingers of a cadaver in which all forces exerted by the intrinsic muscles were removed, were observed to hyperextend maximally at the metacarpophalangeal joint before extension of the proximal interphalangeal joint began. Mathematical calculation of moments provides an explanation of this sequence. This study confirmed that, when an equilibrium of forces at the hyperextended metacarpophalangeal joint is reached, the proximal interphalangeal joint is incompletely extended. These forces include: (1) the proximal pull of the extensor tendon; (2) the distal loading of the extensor tendon by the flexor tendons; (3) the force preventing spanning of the laminae.     

The coordinate movement of the interphalangeal joints. A cinematic study.

No agreement exists on how coordinate flexion and extension movements of the interphalangeal joints of the long fingers of the hand are performed. A cinematic study in 18 healthy volunteers was done to assess the objective sequence of beginning and ending of movement in the eight free movements of the hand in which these joints flex and extend. The results show that the proximal interphalangeal joint is the one that first initiates the four analyzed movements in which these interphalangeal joints flex and the four movements in which these interphalangeal joints extend. The distal interphalangeal joint is the one that ends first in these two groups of movements. These results confirm that the coordinated movements of the interphalangeal joints may be explained based exclusively on the tendinous system and especially on the setup and balance that exists between the components of the extensor apparatus (longitudinal sliding of the central slip and lateral bands and either the dorsal to palmar or palmar to dorsal displacement of the lateral bands with respect to the rotation axis of the proximal interphalangeal joint).     

足第二趾近侧趾间关节移植再造拇手指关节

目的 报道游离足第二趾近侧趾间关节移植再造拇手指关节临床疗效.方法 对手指关节损伤49例54指,采用吻合血管的足第二趾近侧趾间关节移植修复,其中再造掌指关节21指、近侧指间关节28指、远侧指间关节5指.全关节移植38指,半关节移植16指,术后观察其临床疗效.结果 移植关节49例54指全部成活.术后伤口均一期愈合.随访5～19个月,所有病例移植骨关节均愈合,临床愈合时间为4～8周,骨性愈合时间6～12周,移植关节均未出现退行性变,未出现骨不连及再骨折的现象.移植近侧指间关节屈曲活动度为35°～90°(平均65°);移植掌指关节者屈曲活动度为30°～75°(平均45°);移植远侧指间关节屈曲活动度为25°～65°(平均35°).参照关节活动度TAM/TAF评定标准评定,属优者23指,良者25指,可者5指,差者3指,优良率84%.近侧指间关节移植者效果最佳,其次是掌指关节,远侧指间关节移植者最差.结论 采用游离足第二趾近侧趾间关节移植修复拇手指关节缺损,功能恢复满意,可以较好的改善关节的功能.     

Proximal interphalangeal joint stiffness: measurement and analysis

PURPOSE: The purpose of this study was to quantify the stiffness of the human finger proximal interphalangeal (PIP) joint and to study its relationship to different common clinical parameters. METHODS: Eighty-nine normal adult subjects had their PIP joints of the index, middle, and ring fingers evaluated using a computer-controlled moment-angle plotter. This device was used to measure stiffness and energy absorbed at the PIP joint during passive flexion and extension. RESULTS: The average overall stiffness was 0.05 N-cm/degree. There was a weak correlation between stiffness and energy absorbed and the size of the finger: they both increased with the size of the finger. The men's fingers were stiffer and absorbed more energy than the corresponding women's fingers. No significant associations were found between the time of day when the test took place, occupation, hobbies, or age with stiffness or absorbed energy. No significant differences were associated with hand dominance. The finger on the dominant hand had a larger circumference for both genders. Heavier individuals had more stiffness and absorbed more energy than lighter individuals. CONCLUSIONS: The PIP joint stiffness was defined quantitatively and measured over a wide cross-section of a normal population. This may allow future studies to record the outcome of different treatments for finger joint stiffness objectively. The stiffness was greater in men and in larger fingers.     

Deviation of a finger at the proximal interphalangeal joint caused by juxta-articular exostosis.

An exostosis around the interphalangeal joint can cause deformity of a finger. We present two children with deviated fingers as a result of exostoses that developed near the proximal interphalangeal joints and were successfully treated by resection and closed wedge osteotomy.     

应用微型钢板与交叉克氏针融合手指近指间关节的疗效对比

目的探讨应用微型铜板螺钉与交叉克氏针融合手指近指间关节的手术疗效。方法对53例79指近指间关节内骨折、骨缺损患者,分别采用微型钢板螺钉和交叉克氏针固定进行关节融合,其中A组30例47指行微型钢板螺钉固定,B组23例32指行交叉克氏针固定。术后分别对并发症、骨愈合情况以及功能恢复进行比较。功能恢复情况按照TAM功能评定标准进行比较。结果术后随访4～24个月,平均11个月。A组无感染及皮肤坏死,无延迟愈合、骨不连及旋转畸形。融合关节临床愈合时间为6～8周,平均7．3周,X片示骨性愈合时间为8～9周;B组针道感染3指,旋转畸形3指．延迟愈合4指,无骨不连。融合关节,临床愈合时间为7～15周,平均11．2周。X片示骨性愈合时间为10～16周。优良率A组为90．7％,B组为67．1％。术后并发症：A组在邻近关节僵硬、局部不适及肌腱粘连等方面均低于B组。结论微型铜板固定近指间关节融合明显优于交叉克氏针固定。     

The terminal tendon of the digital extensor mechanism: Part II, kinematic study

PURPOSE: To conduct kinematic analyses of both intact and sectioned terminal tendon (TT) of multiple fingers in the hand. METHODS: The TTs of 36 fresh-frozen cadaveric digits were used in this study. TT excursion was assessed along with the influence on proximal joint motion. The influence of TT lengthening and shortening on distal interphalangeal (DIP) joint motion were investigated. RESULTS: TT excursion averaged 1 mm at the DIP joint and was influenced by the proximal interphalangeal (PIP) joint but not the position of other joints in the hand and wrist. The greatest degree of DIP joint motion averaged 86 degrees when the PIP joint was in full flexion, whereas the least motion averaged 45 degrees when this joint was in neutral position. Lengthening of the TT resulted in angular deformity at the DIP joint. Average flexion deformities reached 25 degrees at 1 mm, 36 degrees at 2 mm, 49 degrees at 3 mm, and 63 degrees at 4 mm of lengthening. The middle finger showed the greatest flexion deformity, followed by the ring, small, and index fingers. Shortening the TT by as little as 1 mm resulted in difficult tendon repair because of excessive tension and minimal or no DIP joint flexion was obtained. CONCLUSION: Only DIP and PIP joints affect TT excursion; hence these are the main joints to be immobilized to protect TT repair. The middle finger TT showed the least tolerance to lengthening with potential for mallet deformity. Joint flexion deformity is proportional to tendon lengthening. Only 1 mm of TT lengthening results in approximately 25 degrees of DIP joint extension lag, and 4 mm of TT lengthening results in DIP joint flexion deformity greater than 60 degrees . Even 1 mm of TT shortening will seriously restrict DIP joint flexion.     

Finger joint reconstruction with costal osteochondral graft

Cartilage disorders of the finger joint may influence hand function. Loss of integrity of the finger joint may severely compromise its stability and may lead to degenerative arthritis. Anatomical reduction of the finger cartilage should be as precise as possible in treating cartilage defects due to trauma and other causes. We have repaired cartilage defects in finger joints by arthroplasty with costal osteochondral grafting in 29 patients (30 joints) since 1997. Three patients underwent total joint reconstruction using costal osteochondral grafting for complete bony ankylosis (1 metacarpophalangeal joint and 2 proximal interphalangeal joints). The purpose of this study was to describe the history, indications, and surgical techniques of the costal osteochondral graft for cartilage disorders or defects in the metacarpophalangeal and proximal interphalangeal joints.     

Impact of simulated proximal interphalangeal arthrodeses of all fingers on hand function

PURPOSE: To evaluate the impact of simulated proximal interphalangeal (PIP) arthrodeses on hand performance and to assess the resulting compensatory metacarpophalangeal (MCP) joint motions in healthy subjects. METHODS: Fifteen healthy subjects were tested under 2 conditions: (1) with unrestricted distal interphalangeal, PIP, and MCP joints and (2) with the PIP joint fixed at 40 degrees of flexion in all 4 fingers of 1 hand and unrestricted MCP and distal interphalangeal joints. Subjects performed the Jebsen hand function test and 13 activities of daily living. Perceived difficulty in performing tasks was assessed with a study-specific questionnaire. The motion of each finger was monitored using a motion analysis system. RESULTS: The average time to complete the Jebsen test did not increase significantly with simulated PIP arthrodesis, nor did subjects perceive the tasks to be more difficult. Activities of daily living tasks requiring power grasp did not show significant increases in MCP flexion or abduction. Precision handling tasks requiring greater PIP joint flexion did show increased MCP flexion and were associated with greater perceived difficulty. CONCLUSIONS: Our study showed a minimal overall impact from simulated arthrodeses of all 4 fingers at the PIP joints in 40 degrees of flexion when measured by selected lower-demand activities of daily living in healthy subjects. Precision handling tasks that normally use higher degrees of PIP joint flexion, however, were perceived to be more difficult to perform and required greater compensatory motion at the MCP joints. This study does not address directly the impairment that patients with generalized hand arthritis may experience after PIP joint arthrodesis. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic, Level I.     

Immobilization of the mallet finger. Effects on the extensor tendon

Since the mallet finger that is treated with isolated splinting of the distal interphalangeal (DIP) joint can be moved freely proximal to the DIP joint, we sought to determine whether such motion might cause a tendon gap that could explain the extensor lag that often follows treatment. Experiments were performed on 32 cadaveric fingers with open mallet finger lesions, immobilizing either the DIP joint alone or both the DIP and PIP joints, while repeatedly flexing and extending the more proximal finger and wrist joints. For each experiment, the gap in the extensor tendon was measured. Joint motion proximal to the DIP joint and retraction of the intrinsics did not cause a tendon gap in a finger with a mallet lesion, supporting the convention that only the DIP joint needs to be immobilized.     

DEVIATION OF A FINGER AT THE PROXIMAL INTERPHALANGEAL JOINT CAUSED BY JUXTA-ARTICULAR EXOSTOSIS

An exostosis around the interphalangeal joint can cause deformity of a finger. We present two children with deviated fingers as a result of exostoses that developed near the proximal interphalangeal joints and were successfully treated by resection and closed wedge osteotomy.     

Functional range of motion of the joints of the hand

Active ranges of motion of the joints of the hand are well documented, but there is little data reporting the functional ranges of motion required to perform activities of daily living. Electrogoniometric and standard methods were used to measure both active and functional ranges of motion of the metacarpalphalangeal and interphalangeal joints during 11 activities of daily living. In the fingers, only a small percentage of the active range of motion of the joints was required for functional tasks. Functional flexion postures averaged 61 degrees at the metacarpalphalangeal joint, 60 degrees at the proximal interphalangeal joint, and 39 degrees at the distal interphalangeal joint. In the thumb, functional flexion postures averaged 21 degrees at the metacarpalphalangeal joint and 18 degrees at the interphalangeal joint using only 32% of the available flexion. Active thumb metacarpalphalangeal joint motion was found to be bimodal in the study group.     

Simultaneous double dislocation of the interphalangeal joint in a finger

Isolated traumatic dislocation of the distal and proximal interphalangeal joints of the fingers is a common occurrence. However, simultaneous dislocation of both interphalangeal joints in a single finger appears to be a rare event. We report five cases of simultaneous dislocation of both interphalangeal joints in a single finger with a review of the literature.     

Reconstruction of phalangeal articulations of the hand with vascularised phalangeal articulations of foot

SUMMARY: Since arthroplasty, prosthetic replacement and non-vascularised articulation autografting do not normally produce very satisfactory results for ankylosis of metacarpophalangeal and interphalangeal joints, the authors performed reconstruction of phalangeal articulations of the hand using vascularised phalangeal articulations of the foot in 11 patients with ankylosis of the metacarpophalangeal and interphalangeal joints of hand due by trauma. Procedures included reconstruction of 9 hand metacarpophalangeal joints with vascularised grafting of pedal metatarsophalangeal joints in six patients, reconstruction of the hand metacarpophalangeal joints with grafting of vascularised proximal interphalangeal joints of foot in two patients and reconstruction of the hand proximal interphalangeal joints with grafting of vascularised proximal interphalangeal joints of foot in three patients. Early functional exercise was encouraged in all cases post-operatively. Follow-up ranged from 3 to 10 years and revealed that 9 cases had normal appearance and length of recipient area, 1 had slightly clumsy dorsal skin in the hand and 1 had slight dorsal angulation of a metacarpal bone. Recovery of joint range of motion was satisfactory. Radiographic, gross and sensation examinations also showed good operative outcomes. The authors believe that vascularised pedal metatarsophalangeal joints, with a rich blood supply, can be grafted to effectively reconstruct the finger joints with good function. A low rate of degeneration results because pedal and hand metatarsophalangeal joints are similar in anatomy and physiological function.