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。

Transplantation of the joint with blood supply for reconstruction of metacarpophalangeal joint

Objective To investigate the effect of transplantation of the joint with blood supply for reconstruction of metacarpophalangeal joint The different method of reconstructive joint were compared and reported Methods The losses of 18 metacarpophalangeal joints were reconstructed by 6 different methods in this series The metatarsophalangeal joint flaps with vascular anastomoses were applied in 5 cases, the composite flaps of combined metatarsophalangeal joint and a skin flap with vascular anastomoses were applied in 5 cases, the interphalangeal joint of the 2nd toe with vascular anastomoses were applied in 4 cases, two joint flap with skin flap and others without skin flap among 4 cases The composit flaps combined a metatarsophalangeal joint and a interphalangeal joint based on same vascular pedicle was used to reconstruct two adjacent metacarpophalangeal joints in 1 case The metacarpophalangeal joint of the digital stump with vascular pedicle was used in 2 cases Results All reconstructed metacarpophalangeal joints were survived in this series but the fracture nonunion in 1 case and malformation of the reconstructed joint in 1 case The active mobility ranges of the reconstructed joints was from 15 degree to 85 degree(main 5/65 degree) in follow up avergaing 27 months Conclusions It is a effective method that the the transplantation of the joints with blood supply are used to reconstruct metacarpophalangeal joints Key words] Metacarpophalangeal joint; Surgical flap; Joint; Transplantation; Reconstruction