保留足趾的自体复合第2足趾关节移植治疗手指关节炎

目的 探讨保留足趾的自体复合第2足趾关节移植治疗手指关节炎的临床疗效.方法 2016年2月至2018年6月,共收治创伤性手指关节炎9例,其中男7例,女2例;年龄19~53岁,平均31.7岁;示指3例,中指6例;掌指关节(MP)关节炎4例,近侧指骨间关节(PIP)关节炎5例;均为创伤后继发的手指关节炎.采用游离带血供的自体复合第2足趾跖趾或趾骨间关节移植进行治疗,同时将受区废弃关节(7例)或切取自体髂骨移植(2例)修复供区骨缺损保留足趾长度,供区创面均直接关闭.术后观察手指和足趾骨折愈合情况、外形、移植关节活动度(ROM)、术后供区愈合情况和行走功能及相关并发症.结果 本组术后9例移植关节全部成活,1例足部供区行髂骨植骨微型钢板固定,术后1周伤口不愈合,考虑为内固定物排异反应,予拆除钢板改克氏针交叉固定,2周后创口顺利愈合.术后随访6~30个月,平均16.3个月.手指骨折平均愈合时间7~10周,平均8.3周,手指外观及功能良好.移植后的MP活动度为50°~75°,平均65.3°,PIP活动度为10°~85°,平均60.6°.根据中华医学会手外科学分会上肢部分功能评定试用标准评价手指功能:优5例,良3例,可1例,优良率为88.9%.足趾骨折平均愈合时间9~12周,平均10.2周,所有患者足趾外形良好,行走功能正常.2例取髂骨患者供区仅残留一条线形瘢痕,无疼痛、麻木等不适.结论 游离带血供的自体复合第2足趾关节移植治疗手指关节炎,同时应用受区废弃关节或切取自体髂骨移植修复供区骨缺损保留足趾,不仅能恢复手指关节的正常结构,使关节具有良好的功能,而且能保留足趾外形与功能,减少供区损伤,具有良好的治疗效果.

Transplantation of metatarsophalangeal and proximal interphalangeal joint of second toe with toe preserva-tion in repairing traumatic digital arthritis

Objective To evaluate the clinical outcome of transplantation of metatarsophalangeal and proximal interphalangeal joint of the second toe with toe preservation for repair of traumatic digital arthritis.Methods From February,2016 to June,2018,nine cases with traumatic digital arthritis were treated,including 7 males and 2 females aged from 19 to 46(average 26.7)years.Three cases had index finger and 6 middle fingers injuried.Four cases had arthritis in metacarpophalangeal joint(MP)and 5 in proximal interphalangeal joint(PIP).All cases with digital arthritis were secondary to trauma.The involved digital joints were reconstructed by transplanting the MP or PIP of the second toes.At the same time,the affected joints(7 cases)or autologous iliac bone grafts(2 cases)were used to repair the bone defects to retain the length of toes.The donor site were closed directly.The appearance and healing of fractures of the fingers and toes,range of motion(ROM)of the transplanted digital joint,healing of the donor site,foot function and complications were observed.Results All 9 grafted joints survived.In 1 case,the bone defect in the donor site was fixed with iliac bone graft and mini-plate.The wound did not heal at 1 week after operation,which was considered as a rejection of internal fixator.The wound healed smoothly after having the plate removed and replaced it with a cross-fixation by Kirschner pins.Duration of postoperative followed-up was 6-30(mean 16.3)months.Primary postoperative healing was achieved in all cases.The bone healing time in the hand was 7 to 10(mean 8.3)weeks.The appearance and function was satisfactory.The postoperative range of motion(ROM)in the transferred MP was 50°-75°(mean 65.3°),and ROM of PIP was 10°-80°(mean 61.5°).According to the evaluation standard of upper limb function set up by the Society of Hand Surgery of Chinese Medical Association,excellent in 5 cases,good in 3 cases and fair in 1 case,with an overall satisfaction of 88.9%.The bone healing time in the foot was 9 to 12(mean 10.2)weeks.All cases presented with good appearance of the toe without obvious affect to walking and running.For the ilium,there was only an inconspicuous linear scar without any discomfort in the donor iliac area of 2 cases.Conclusion Transfering of MP and PIP of the second toe with toe preservation can restore the anatomy structure and function of the digital joint.Meantime,the use of autogenous iliac bone graft to replace the donor site defect may retain the length of the toe and minimizes the injury to the donor site.