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.     

游离趾间半关节移植修复第二掌指关节缺损的临床应用

目的 讨论游离第二趾间半关节移植修复第二掌指关节缺损的临床疗效.方法 2006年12月至2010年11月,本院临床应用32 例,行游离趾间半关节移植修复第二掌指关节缺损手术,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.其中26 例于术后3个月～2 年得到随访,按中华医学会手外科学会功能评定试用标准进行评定,第二掌指关节均获得较良好的功能恢复,吻合血管的单纯带关节囊半关节移植效果最佳,吻合血管的带肌腱及关节囊趾间半关节和复合组织的半关节移植效果次之,不吻合血管的半关节移植效果较差,其中1例出现关节面吸收,另1例出现骨不连.结论选用第二足趾半关节移植是治疗第二掌指关节缺损的较好方法,其中吻合血管的单纯带关节囊半关节移植效果最佳.     

自体跖趾关节复合组织瓣移植修复创伤性掌指关节缺损

目的探讨自体第2跖趾关节复合组织瓣移植修复创伤性掌指关节缺损的方法和疗效。方法 2005年6月-2009年12月,对6例创伤性掌指关节缺损采用第2跖趾关节携带趾伸屈肌腱、趾固有神经及跖侧、背侧皮瓣的复合组织瓣进行修复。患者均为男性;年龄18～48岁。机器冲压伤3例,挤压伤2例,其他伤1例。第2、3、4掌指关节缺损各2例,缺损范围1.5cm×1.5cm～3.0cm×2.5cm。均伴有皮肤软组织缺损,缺损范围4cm×2cm～5cm×4cm。5例合并伸肌腱缺损,缺损长度2.5～5.0cm;3例合并屈肌腱断裂;3例合并指总神经损伤。受伤至入院时间2～6h。结果术后复合组织瓣全部成活,创面Ⅰ期愈合;供区植皮成活,切口Ⅰ期愈合。6例均获随访,随访时间1～5年。X线片示术后9～14周骨组织临床愈合良好,移植的跖趾关节与掌、指骨完全愈合。皮瓣外形不臃肿,质地柔软,痛、触觉恢复。末次随访时移植的掌指关节活动度达掌屈50～70°,背伸5～10°。按中华医学会手外科学会上肢部分功能评定试用标准,获优4例,良1例,可1例,优良率达83.3%。足部供区无明显功能障碍。结论应用自体跖趾关节复合组织瓣修复创伤性掌指关节缺损可用一个供区同时修复跖趾关节掌、背侧皮肤及骨、肌腱、神经的缺损,为复杂手外伤提供了一种有效的、可一次性修复的手术方法。     

第二跖趾关节移植重建掌指关节功能

目的应用第二跖趾关节移植方法修复陈旧性掌指关节缺损，以重建掌指关节功能。方法对陈旧性创伤性掌指关节缺损、关节融合指体缩短7例，先以手指延长器行指延长，二期施行第二跖趾关节移植重建掌指关节。结果手指平均延长2．6cm，移植关节全部成活，并骨性愈合。随访1～4年，手功能恢复按中华医学会手外科学会上肢部分功能评定试用标准评价：优2例、良4例、可1例，优良率85．7％。结论应用第二跖趾关节移植方法修复伴指体短缩的陈旧性掌指关节缺损，效果良好。     

第二跖趾关节移植在掌指关节重建中的应用

目的探讨第二跖趾关节游离移植重建掌指关节的新方法。方法通过对成人废弃下肢标本6侧,在放大6～10倍手术显微镜视下,解剖并观察第二跖趾关节血供及测量关节活动范围的应用解剖学研究,并在该研究基础上,临床采用不同术式的第二跖趾关节移植,修复掌指关节缺损34例。其中对第一掌指关节重建,将游离关节的跖骨直接与掌骨成30°～45°固定。对2～5指掌指关节重建,采用跖骨头下关节面45°截骨,同时将过厚的跖板在保留关节囊完整及部分跖侧屈肌腱鞘的情况下作楔形切除,原跖骨断端重新对合,纵行克氏针固定。结果术后34例掌指关节全部存活。手功能评定:优22例,良7例,可3例,差2例;优良率为85%。X线片显示骨折愈合良好。结论采用跖骨与掌骨成角固定及跖骨头下关节面45°截骨的方法,行第二跖趾关节游离移植重建掌指关节,该方法可行、有效。     

有血运关节移植再造掌指关节

目的　探讨与比较再造手部关节缺损的方法 ,报道不同关节及关节瓣移植的临床效果。　方法　应用吻合血管的跖趾关节移植 5例、跖趾关节皮瓣移植 5例、趾间关节瓣移植 2例、趾间关节皮瓣移植 2例 ,同一血管蒂带跖趾关节与趾间关节复合瓣一期重建相邻两掌指关节 1例 ,带血管蒂残存掌指关节瓣转移 2例。共再造掌指关节 17例 18个。结果　全部组织瓣存活。经平均 2年 3个月 (6个月～ 7年 )随访 ,再造掌指关节平均活动度为 5°～ 5 6°(范围 15°～ 85°) ;出现骨不连接和关节畸形各 1例。　结论　有血运关节移植再造掌指关节 ,术后功能与外形恢复良好 ,但总体疗效仍有待提高。     

改良第二跖趾关节移植修复木工机械致掌指关节背侧缺损

目的 探讨一种新的改良第二跖趾关节移植修复木工机械致掌指关节背侧缺损的方法及临床疗效.方法 2006年12月至2011年12月,针对木工机械致掌指关节损伤的特点,设计并改良第二跖趾关节复合组织瓣,经过重建,保留复合组织瓣背侧半,用于修复掌指关节冠状面背侧复合组织缺损共16例23个掌指关节.结果 17个修复的掌指关节获得随访,时间6～24个月,X线片提示骨骼愈合.重建掌指关节均获得较好的功能恢复.按中华医学会手外科分会拇手指再造功能评定试用标准评定,优良率为94.12％.结论 改良第二跖趾关节移植修复木工机械致掌指关节背侧缺损临床可行,能有效改善损伤掌指关节的功能.     

吻合血管的第二跖趾关节游离移植置换第二掌指关节11例

目的总结吻合血管的第二跖趾关节游离移植置换第二掌指关节的临床经验。方法手术时切除破坏的第二掌指关节及部分第二掌骨和近节指骨，将第二跖趾关节转移至手部第二掌指关节处，在鼻烟窝处将足背动脉与桡动脉吻合、大隐静脉与头静脉吻合，将切除的第二掌指关节的软骨关节面和骨骼的软组织剔除后回植到足部第二跖趾关节供区。结果临床应用11例，其中8例于术后5个月-2年6个月得到随访，第二掌指关节均获得较良好的功能恢复。结论吻合血管的第二跖趾关节游离移植置换第二掌指关节，能有效地恢复第二掌指关节的功能。     

改良跖趾关节游离移植置换掌指关节的临床应用

目的总结改良吻合血管的第二跖趾关节游离移植置换第二掌指关节的临床经验。方法手术切除破坏的第二掌指关节及部分第二掌骨和近节指骨，将第二跖趾关节转移至手部第二掌指关节处，在鼻烟窝处将足背动脉与桡动脉吻合、大隐静脉与头静脉吻合，将切除的第二掌指关节的软骨关节面和骨骼的软组织剔除后回植到足部第二跖趾关节供区。结果临床应用14例，其中12例于术后5个月～3年2个月得到随访，第二掌指关节均获得较好的功能恢复。结论改良的第二跖趾关节游离移植置换第二掌指关节术式，能有效地恢复第二掌指关节的功能。     

保留足趾的趾关节游离移植修复手指关节缺损

目的为了修复外伤造成的手指关节（掌指关节、近节指间关节）缺损,介绍一种既能保留第2足趾．又能修复指关节缺损的带血管和皮肤及近节趾间关节的足趾骨瓣,并评价其疗效。方法对6例由外伤造成的指骨缺损合并指关节损伤患者,采用切取同侧中趾近节带皮肤、第2趾胫侧跖背动静脉、神经和近趾关节的骨瓣进行修复。皮瓣面积：1．0cm×2．0cm×1．5cm×3．0cm。结果6例指关节损伤全部修复,手指关节功能基本恢复正常,未见感染及关节坏死。结论带血管的第2足趾近节趾关节骨瓣修复外伤性指关节损伤,可以减轻患者手指功能障碍的痛苦,同时保留了第2足趾的外观形态,手术效果满意．切取方便．而且对供区足趾外形影响较小。     

Proximal interphalangeal joint arthritis

Proximal interphalangeal joint function is critical for proper finger and hand function and arthritis of this joint can lead to considerable hand impairment. Proximal interphalangeal joint arthritides are broadly categorized into nonerosive and erosive osteoarthritis (OA), posttraumatic arthritis, and inflammatory arthritis. The nonerosive type is considered idiopathic or primary OA, whereas the erosive form exhibits an inflammatory component. Idiopathic or primary OA occurs as a consequence of abnormal mechanical stress that leads to damage of cartilage and subchondral bone, with subsequent cytokine and growth factor activation. Individual genetics then mediate the cellular responses. Although erosive OA is described as a separate entity, this remains controversial, with many suggesting that it is merely a more aggressive form of nonerosive, primary OA. Inflammatory OA occurs when connective tissues are diseased, allowing for normal use to incite arthritic damage. Treatment modalities for proximal interphalangeal joint arthritis are currently limited.     

Osteoarthritis of the distal interphalangeal joint

Osteoarthritis occurs with the highest prevalence in the distal interphalangeal joint of the hand and has been divided into an erosive and a nonerosive form. The pathogenesis of the early stages of osteoarthritis is poorly understood, but considerable emphasis has been placed on the role of cartilage and subchondral bone as well as soft tissue structures such as collateral ligaments and tendons. Radiographic evaluation represents the most standardized method to quantify disease progression, with different systems having been developed for defining and grading radiographic features. This current concepts article examines the recent knowledge base regarding the etiology, pathogenesis, and evaluation of osteoarthritis of the distal interphalangeal joint.     

Arthrodesis for degenerative disease of the hallux metatarsophalangeal and interphalangeal joints

Arthrodesis of the hallux metatarsophalangeal (MTP) or interphalangeal (IP) joint is a sound surgical solution to degenerative disease of these joints. Where conservative measures have failed, MTP or IP arthrodesis can alleviate pain and normalize gait. Preoperative planning should include evaluation of the skin, bone quality, and range of motion of the involved and adjacent joints. The technique of joint preparation described allows for easily individualized fusion position and maintenance of length. In patients with adequate bone stock, the fixation techniques described provide for compression and obviate the need for removal for most patients. Where bone stock is questionable, plate fixation can provide stability, improving results. With careful patient selection, preoperative planning, and conservative postoperative care, predictable results can be obtained with these techniques.     

Morphology of the interphalangeal joint surface and its functional relevance

PURPOSE: To study and to clarify the curvature morphology of the articular surfaces of the proximal interphalangeal (PIP) joint and to relate joint morphology and joint kinematics. METHODS: The radii and centers of curvature of 40 PIP joints were determined by sagittal and transverse intersections of highly precise replicas that were prepared by dental methods. RESULTS: The PIP joint is proved to be a nonconforming joint: the articular surface of the proximal end of the middle phalanx has lesser curvatures than the condyles of the proximal phalanx. In intersections through the apex of the radial and ulnar condyles, the measured differences of the radii between the articular surfaces of the PIP joint were sagittally about 30% and transversely about 49% of the respective radii of the condyles. Incongruity of the joint results in 2 morphologically given axes for extension respective to flexion: (1) an axis given by the articular surfaces of both condyles of the proximal phalanx; and (2) a second axis given by the articular surface of the proximal end of the middle phalanx. Both articulating surfaces have 2 contact points in the transverse plane, one each, central to the apex of radial and ulnar condyles, respectively. In the middle of the joint, in the intercondylar groove, a small joint cavity was present in 37 of 40 joints. CONCLUSIONS: The physiological incongruity of the 2 articular surfaces of the PIP joint was defined quantitatively. This allows the derivation of a theoretical model for PIP joint function that explains the kinematics and mechanical stability of the joint as well as the lubrication and nutrition of the cartilaginous structures.     

Alternative to the distal interphalangeal joint arthrodesis: lateral approach and plate fixation

PURPOSE: Several fixation techniques for distal interphalangeal (DIP) joint arthrodesis have been described, with good clinical results and complication rates between 10% and 20%. We propose an alternative technique and fixation method using a lateral approach and 1.3-mm plate and screws fixation. METHODS: Between March and September 2005, 11 patients, totaling 15 fingers, had DIP joint arthrodesis by the described technique. The indications were posttraumatic arthritis in 8 fingers, degenerative or rheumatoid arthritis in 5 fingers, and isolated flexor digitorum profundus tendon lesions in 2 fingers. Patients were analyzed for osseus union, pain relief, and functional mobility of the finger. RESULTS: Arthrodesis relieved pain and restored stability at the 12th week, on average, with osseous union in all patients. All patients maintained full proximal interphalangeal joint motion with pulp-to-palm distance of zero at 6 months of follow-up evaluation. There were no rotational or angular deformities, nail bed lesions, or skin complications. CONCLUSIONS: The lateral approach with plate and screws fixation is an option for DIP joint arthrodesis. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.     

Management of proximal interphalangeal joint injuries

Injuries to the proximal interphalangeal joint are common but frequently missed. They are often overtreated by prolonged immobilization, resulting in stiffness, which may be permanent. The purpose of the present article is to briefly review the relevant anatomy and biomechanics, present an approach to physical examination and diagnosis, and propose a practical clinical classification. The treatment of the most severe injury – the intra-articular fracture dislocation – is controversial. The various treatment options are discussed, based on personal experience and a review of the literature. A list of relevant references is presented.     

Beware the hallucal interphalangeal joint sesamoid in first metatarsophalangeal joint arthrodesis

Background

We describe a previously unreported presentation of the hallucal interphalangeal joint sesamoid (HIPJS) following arthrodesis of the first metatarsophalangeal joint (MTP1).

Volar plate arthroplasty of theproximal interphalangeal joint

Surgical stabilization of dorsal proximal interphalangeal fracture dislocations may be required when more than 40%of the joint surface is disrupted. Volar plate arthroplasty alone, or in combination with other techniques, can be used to reduce and stabilize these difficult injuries. Attention to technical details is important in obtaining good postoperative results.     

Replacement of proximal interphalangeal joints with new ceramic arthroplasty: A prospective series of 20 proximal interphalangeal joint replacements

A prospective consecutive series of 20 proximal interphalangeal (PIP) joints replaced with a new ceramic unconstrained prosthesis (MOJE) included 13 patients with osteoarthrosis, five with rheumatoid arthritis, and one each with post-traumatic infection and traumatic arthrosis. All patients were assessed preoperatively and postoperatively at one year by an independent physiotherapist and an occupational therapist who evaluated grip strength, range of motion, activities of daily living (ADL) and occupational scores (COPM Canadian Occupational Performance Measure). The mean range of motion of the PIP joint improved from 43° to 60° (p=0.001), and the mean grip strength from 169–199 N (p=0.002). The patients’ self-perception of occupational performance, assessed by the COPM, improved significantly from 3.6–6.6 (p<0.001) for satisfaction, and 3.8–6.3 (p<0.001) for performance. The MOJE PIP joint replacement provides significant pain relief, improved strength and range of motion, and short-term satisfaction. Further long-term studies are therefore advocated.