3D预构骨皮瓣联合半关节移植重建掌指关节功能

目的探讨应用3D技术进行术前预构，采用上臂外侧骨皮瓣游离移植联合自体残留掌骨基底关节块带蒂移位修复累及掌指关节的手部复杂缺损、重建患手掌指关节功能的临床疗效。 方法2014年6月至2018年12月，深圳市中西医结合医院手外科收治7例手部复合组织缺损并累及掌指关节近端半关节缺损的病例，常规术前应用3D技术，在电脑上用3D软件模拟手术，并打印患手实体模型，根据掌骨基底关节面倒置移位后掌骨缺损大小，对拟用上臂骨皮瓣的骨量和形态进行预构。术中按拟定设计方案，利用残留掌骨基底关节面，带蒂转位至掌指关节缺损处，修复关节囊，重建掌指关节；同时切取上臂外侧骨皮瓣修复掌骨骨骼及手背软组织缺损。术后所有病例进行早期系统康复锻炼，定期观察随访。 结果术后随访1～4年，移植骨皮瓣存活良好，骨折一期愈合，患手伸屈活动功能及握力恢复满意，皮瓣痛、触觉恢复。根据中华医学会手外科学会上肢部分功能评定试用标准显示结果：优4例，良2例，可1例，优良率85.7%。上臂供区无明显功能障碍，患者对患手的功能和外观非常满意，并返回到日常工作岗位。 结论应用3D技术进行术前预构，利用上臂外侧骨皮瓣游离移植联合残留带蒂掌骨关节面移位可精准、同期重建掌指关节功能并修复骨骼皮肤缺损，患手功能及外观恢复满意，为外伤性累及掌指关节的复合组织缺损的手功能重建修复提供新的思路。

3D prefabricated bone-skin flap combined with hemi-articular transplantation for metacarpophalangeal joint reconstruction

ObjectiveTo investigate the clinical efficacy of repairing complex defect of hand involving metacarpophalangeal joint and reconstructing the function of the metacarpophalangeal joint by application of 3D prefabricated upper limb lateral bone-skin flap combined with basal articular surface of metacarpal with pedicle transposition. MethodsFrom June 2014 to December 2018, seven cases of complex defect of hand involving metacarpophalangeal joint were treated, and surgery was designed preoperatively on the 3D model which was created by using 3D technology and based on the 3D CT scanning data. To simulate surgery on computers and 3D models. Guided by the preoperative design, the functional reconstruction of metacarpophalangeal joint were repaired with basal articular surface of metacarpal with pedicle transposition in the injured hand. Bone and soft tissue defects in the hand were repaired with the upper limb lateral bone-skin flap in same-stage. The patients received actively functional rehabilitation exercise after the surgery then were followed up regularly. ResultsAll the patients were followed up one to four years and successful with complete survival of all the transplanted bone-skin flaps. The X-ray films showed good healing for the transplanted bones and basal articular surface of metacarpal at eight to 12 weeks postoperatively. The movable function and grip strength of injured hand were restored satisfactorily, and the senses of pain and touch were recovered. According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medical Association, the results were excellent in four cases, good in two cases, and fair in one case, and the excellent and good rate of 85.7%. No dysfunction of the donor site of upper arm was observed. Patients were satisfied with outward appearance and function of injured hand, and then to return to work. ConclusionThe method of combined operation is a highly targeted, effective way for reconstructing the function of the metacarpophalangeal joint and repairing bone and soft tissue defects simultoneously, and the outward appearance and function of injured hand are satisfactory, which provides a new technique for the repair of complex defect of hand involving metacarpophalangeal joint.