手部复合组织缺损重建方法回顾

目的 回顾总结手部复合组织缺损修复重建的方法以及对手术方法评价分析.方法 对于手部骨关节、皮肤等复合组织缺损,采用（带血管）自体骨与皮瓣组合,带血管跖趾关节或游离足趾与皮瓣组合等方法,再造重建残缺腕、手与手指.骨、关节及皮肤缺损根据伤情可采用同期重建也可采用分期重建方法,伴有肌腱缺损可采用自体肌腱移植方法二期重建.结果 本组18例经8个月～2年随访,参照中华医学会手外科学会断指再植功能及上肢功能评定试用标准,我们从运动、感觉、外观三方面予以评价：（1）运动功能评价（手指运动功能按手指总活动度,TAM）,优5例,良6例,优良率61.1 %.（2）感觉功能评价：指骨、掌骨、掌指关节重建患者手指感觉功能无明显缺失,优（S5）8例,良（S4）1例;残缺手分期重建病例感觉较差（S3）4例.（3）外观评价（按照外形、臃肿度、有无崎形及患者主观满意度等几方面）：优6例,良7例,美观满意率为72.2 %.结论 采用自体骨与皮瓣组合、自体足趾及关节移植与皮瓣组合等方法重建手部复合组织缺损,能在一定程度上恢复手部外形及功能,降低手和手指伤残程度.

Retrospective analysis of reconstruction for cripple hand and defected digital bone

Objective To study and solve the problem of insufficiency and malformation due to cripple hand and defect of digital bone in fingers, palm, and wrist. This study aims at retrospectively analyzing the methods and evaluation of reconstruction surgery for cripple hand and defected digital bone. Methods Vascularized iliac bone or metatarsophalangeal joints （MPJ） or toes transplantation incorporated with flaps were used to reconstruct the defected bone in palm or fingers. Combined with tendon absence in such cases should be repaired or restituted by tendon autografting in one stage or by stages. Results Total 18 cases including 4 cases of palm defect, 4 cases of articulatio metacarpophalangea defect, 8 cases of metacarpal and digital bone defect, 2 cases of wrist distal radius defect were enrolled in this study. According to the functional assessment criteria of upper limb issued by Society of Hand Surgery of Chinese Medical Association, 18 cases were evaluated from three aspects as the followings in 8-24 months postoperative follow-up： 1. motor function （evaluated by the fingers activity, TAM ）： 5 cases were excellent （61.1%） while 6 cases were good. 2. sensory function： the finger sensory function of patients with digital bone, metacarpal and articulatio metacarpophalangea reconstruction presented with no obvious functional damage. 8 cases （S5） were excellent while 1 cases （S4） were good. The outcomes of the 4 cases treated with reconstruction by stages were poor and not satisfactory （S3）. 3. Appearance （evaluated by appearance, corpulence, tetratogenesis and satisfaction degree of patients）： 6 cases were excellent （satisfactory rate was 72.2% ） while 7 cases were good. Conelusion Vascularized iliac bone, metatarsophalangeal joints （MPJ） or toes transplantation incorporated with flaps were available to reconstruct the defected bone in palm or fingers. We could reduce disability effectively while obtaining a satisfactory outlook and proper functions by such methods.