摘要
目的随访第二足趾游离移植再造拇指的功能，以探讨骨固定术式、功能锻炼开始的时间与肌腱粘连发生率的关系。方法对１９９５年２月至１９９８年６月，行第二足趾游离移植再造拇指２６例的疗效进行评定。掌指关节重建方法：（１）Ａ组：克氏针贯穿固定移植趾与第一掌骨１９例，术后３周后拔克氏针，开始功能训练；（２）Ｂ组：关节囊缝合修复术７例，术后２周行功能训练。术后随访３～３７个月，平均为１１．７个月。结果Ａ组：术后移植指屈曲不能１０例，占５２．６％；Ｂ组：有２例不能屈曲，占２８．６％。经再次行肌腱粘连松解术后，再造指屈曲功能明显改善，Ａ组８例，有效率８０％，Ｂ组２例，有效率１００％，总有效率为９２．３％。结论足趾游离移植术后早期功能训练对于防止肌腱粘连具有重要意义。Ｂ组指屈肌腱粘连的发生率明显少于Ａ组，两组行肌腱粘连松解术后屈指功能均明显改善。
Objective The
cases of second toe transplantation done in recent years were followed to evaluate the
functions of the reconstructed fingers. The incidence of postoperative tendon adhesion, its
causes and the outcome of secondary operations in different surgical procedures were also
discussed. Methods 26 patients who underwent second toe transplantation for thumb
reconstruction in the period from February 1995 to June 1998 were followed. All the patients
sustained posttraumatic degree defect of the thumb. As for the pattern of fixation of the
transferred toe, the metacarpophalangeal joints in all cases were reconstructed in the following
fashions. (1) Fixation of the transferred toe to the first metacarpus by a transarticular Kirschner
wire. There were 19 cases in this group (group A). (2) Fixation of the transferred toe by suturing
the joint capsule. There were 7 cases in this group (group B). In group A, rehabilitation was
started three weeks after the operation when the Kirschner wire was withdrawn. In group B,
supervised rehabilitation started two weeks postoperatively. WTHZResults Tendon adhesion
which led to flexion disability of the reconstructed fingers occurred in 10 cases of group A,
constituting 55.5 %. There were 2 cases of postoperative tendon adhesion in group B,
accounting for 28.6 %. After tenolysis, the flexion function was improved in 8 cases of group A
and 2 cases of group B, constituting 80 % and 100 % respectively. The overall effective rate
was 92.3 %. Conclusions Early rehabilitation after toe transplantation is important for prevention
of tendon adhesion. This study revealed that the incidence of flexor tendon adhesion was
reduced remarkably in cases of joint capsule repair and early postoperative training of digital
flexion movement.
出处
《中华手外科杂志》
CSCD
1999年第2期85-86,共2页
Chinese Journal of Hand Surgery
关键词
康复
肌腱粘连
组织移植
拇指再造
RehabilitationTendonsAdhesionsTissue transplantation
