改良跖趾关节游离移植重建掌指关节的显微解剖及临床应用

目的：为带血供改良跖趾关节全关节及半关节移植修复掌指关节的应用提供解剖学基础，总结该改良关节置换不同术式的临床应用经验。方法：解剖观测30侧经动脉内灌注红乳胶成尸下肢标本,对第2跖趾关节的解剖结构及血供关系进行显微解剖学测量。在解剖学研究的基础上，临床应用吻合血管的改良全关节及半关节重建修复掌指关节14例，其中全关节8例，半关节6例。术后均进行早期系统的康复训练。结果：第2跖趾关节的血供丰富，血管、神经位置恒定。临床应用14例，其中12例于术后5个月～3年2个月得到随访，第2掌指关节均获得较良好的功能恢复，带关节囊半关节移植效果最佳，全关节移植次之。结论：改良的第2跖趾关节游离移植重建第2掌指关节的不同术式，能有效地恢复第2掌指关节的功能。熟悉关节的解剖特点、改良的手术方案、神经关节支的修复及全面的关节结构功能重建是手术的关键。

The replacement of damaged metacarpophalangeal joint with metatarsophalangeal joint:microdissection and clinical application

Objective：To provide anatomic basis for reconstructing of metacarpophalangeal joint by total metatarsophalangeal joint and semi-joint transplantation, and summarize the clinical experience of the improved replacement skills．Methods：Anatomic features and blood supply of the second metatarsophalangeal joints were observed and measured in 30 adult cadaveric limbs perfused with red latex. For 14 cases, the second metatarsophalangeal joint transplantation was conducted to reconstruct metacarpophalangeal joint: total metatarsophalangeal joint transplantation in 8 cases, semi-joint transplantation in 6 cases. Early systematic rehabilitation was carried out after the operation. Results: There were rich blood supply and special anatomic features for the second metatarsophalangeal joint. The location of blood vessels and nerve were constant. The follow-up of 5 to 38 months in 12 out of 14 cases showed satisfactory functional recovery was achieved．The movement of second metacarpophalangeal joint was excellent．The result of semi-joint transplantation with joint capsule was the best, total joint transplantation the good. Conclusions：The function of the second metacarpophalangeal joint can be effectively recovered by the improved transfer of the vascularized second metatarsophalangeal joint．The elements for succeed operations including the knowledge of anatomic features of the joints, modified transplantation methods, the repairing of articular branches of nerve, and total reconstruction of joint functions.