摘要：
Objective To evaluate the clinical outcome of reconstruction of traumatic digital arthritis by transfer of free proximal interphalangeal joint of the second toe with toe reserving technique.Methods The study enrolled nineteen patients with traumatic digital arthritis treated from May 2013 to April 2016.The patients consisted of fifteen males and four females,and mnean age was 27.3 years (range,18-52 years).Finger involved included index fingers in 10 patients,middle fingers in seven and ring fingers in two.The joint of digit was reconstructed by transplanting the proximal interphalangeal joint of the second toe with a monitoring flap,and bone defect of the second toe was repaired with autogenous iliac bone graft.Wound was closed directly in six patients and covered by island flap from the foot dorsurn in 13 patients.Evaluation indicators contained survival rate of the free joint and island flap,appearance and fracture healing of the finger and toe and mnotion of the proximal digital joint.Finger function was studied using the evaluation standard of upper limb function set up by hand surgery branch of Chinese Medical Association.Healing in the donor site,foot function and related complications were observed.Results All the free joint and island flap survived.Period of follow-up was 6-30 months (mean,14 months).The fractured finger healed at 2.5 months on average,and appearance of the finger was good.Flexion range of the proximal digital joint was 63 °-80° (mean,74°) and extension range was-20°--10° (mean,-14°).Finger function was excellent in eleven patients and good in eight patients,with the excellent-good rate of 100％.Hematoma of the dorsal region of the foot occurred in one patient and the cut healed well after taking out some stitches and drainage.All fractured toe healed at 2.6 months.Except that one patient had fracture malunion with minor outward inclination,all presented good appearance of the toe without influencing walking and running.On the part of iliac,there was only one inconspicuous linear scar without any discomfort.Conclusions Transfer of free proximal interphalangeal joint of the second toe with toe preservation restores the anatomy structure and function of the digital joint.Meantime,autogenous iliac bone grafting combined with island flap from the foot dorsum for coverage of donor site defect retains the toe length and reduces injury of the donor site.%目的 探讨保留供区足趾的游离足二趾近侧趾间关节移植治疗创伤性指问关节炎的疗效. 方法 回顾性分析2013年5月-2016年4月收治19例创伤性指间关节炎患者的临床资料,其中男15例,女4例;年龄18～52岁,平均27.3岁.示指10例,中指7例,环指2例,均为继发于创伤而导致的手指近侧指间关节炎.采用带皮岛的保留足趾的游离足二趾近侧趾间关节移植进行治疗,同时采用白体髂骨植骨移植修复二趾骨缺损,创面直接缝合(6例)或行足背岛状皮瓣转移进行修复(13例).术后观察游离组织及足背岛状皮瓣的成活情况、手指和足趾骨折愈合情况、手指及足趾外形、手指近侧指问关节伸屈活动度,根据中华医学会手外科学分会上肢部分功能评定试用标准评价手指功能,观察术后供区愈合情况和行走功能及相关并发症. 结果 术后19例游离组织全部成活,13例足部岛状皮瓣全部成活.术后随访6～ 30个月,平均14个月.手指骨折平均愈合时间为2.5个月,手指外观良好.手指近侧指间关节屈曲63°～80°,平均74°,伸直为-20°～-10°,平均-14°.手指功能:优11例,良8例,优良率为100％.1例出现足背血肿,给予拆线引流后切口愈合.足趾骨折平均愈合时间为2.6个月,仅1例发生足趾骨折畸形愈合且有轻度外斜,其余患者足趾外观良好,不影响行走及跑步.髂部只形成一条线性瘢痕,无疼痛麻木等不适. 结论 保留足趾的游离足二趾近侧趾间关节移植治疗手指创伤性指问关节炎,同时应用白体髂骨植骨联合足背岛状皮瓣修复足二趾供区,不但能恢复指间关节的正常结构,使关节具有良好的功能,而且能保留供区足趾长度,减少供区损伤,具有良好的治疗效果.
