Tsubokawa Naoto, Yoshizu Takae, Maki Yutaka
Niigata Hand Surgery Foundation, Japan.
J Hand Surg Am. 2003 May;28(3):443-7. doi: 10.1053/jhsu.2003.50087.
To review the long-term clinical results of free vascularized second toe joint transfers for severely damaged finger proximal interphalangeal (PIP) joints.
Eleven joints in ten patients (1 woman, 9 men) were reviewed between 10 and 22 years after surgery. The average patient age at the time of the surgery was 32 years. Patients were evaluated at a mean follow-up time of 15 years; evaluation included range of motion of the transferred PIP joints and the remaining healthy second toe PIP joints, grip strength, finger and toe pain, finger function, gait disturbance, patient satisfaction, and x-ray changes.
The mean active range of motion was 47 degrees that lacks 41 degrees extension and flexes to 88 degrees. The mean grip strength was more than 80% that of the nonaffected hand, and no finger pain or gait disturbances were reported. All patients had some extension lag and flexion contractures but most were satisfied with the clinical and functional results of surgery. In all joints, the joint spaces were preserved, although 1 patient had arthritis and 3 had osteophytes.
It is important to prevent extension lag and flexion contracture to get better results from free vascularized second toe joint transfers. The transferred toe PIP joint is durable.
回顾游离带血管蒂第二跖趾关节移植治疗严重损伤的手指近端指间（PIP）关节的长期临床效果。
对10例患者（1例女性，9例男性）的11个关节进行术后10至22年的随访。手术时患者的平均年龄为32岁。患者平均随访时间为15年；评估内容包括移植的PIP关节和剩余健康第二跖趾关节的活动范围、握力、手指和脚趾疼痛、手指功能、步态障碍、患者满意度以及X线变化。
平均主动活动范围为47度，伸展缺失41度，屈曲至88度。平均握力超过健侧手的80%，未报告手指疼痛或步态障碍。所有患者均有一定程度的伸展滞后和屈曲挛缩，但大多数患者对手术的临床和功能结果满意。在所有关节中，关节间隙均得以保留，尽管有1例患者患有关节炎，3例有骨赘形成。
为了从游离带血管蒂第二跖趾关节移植中获得更好的效果，预防伸展滞后和屈曲挛缩很重要。移植的跖趾关节耐用。
