Zimmermann R, Sailer R, Pechlaner S, Gabl M
Department of Trauma Surgery and Sports Medicine, University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Arch Orthop Trauma Surg. 2003 Dec;123(10):521-6. doi: 10.1007/s00402-003-0549-1. Epub 2003 Jun 27.
Aim of this retrospective study was to obtain a functional outcome following callus distraction and phalangization of the thumb after traumatic amputation in the middle one-third.
From January 1998 to June 2001, 12 patients were treated in a staged procedure starting with corticotomy and continuous distraction (1 mm/day) of the first metacarpal bone using a unilateral external fixator device. After distraction until day 31 (range 25-35 days), the first metacarpal bone was stabilized with a plate, and phalangization was performed. RESULTS. At follow-up 1 year after surgery, the thumb was lengthened to 25-35 mm (average 28 mm) in all but 1 patient. In 1 patient a bone graft from the iliac crest had to be interposed. Pinch grip improved by 45%; grip strength improved by 55%. The function/symptom score from the DASH questionnaire was 25 points (range 16-38 points). In a 'pick-up test' all patients were able to pick up a pencil, they were able to write and could hold a full cup of water. Nine patients were able to pick up a paper clip, and 8 patients could hold a 1-liter bottle of water.
Callus distraction can be considered a suitable procedure to reconstruct an amputated thumb levelled at the middle one-third. Additional phalangization proved essential as it deepened the first web space, enabling good motion and grasp. Callus formation was delayed in elderly patients, but adequate lengthening and bone healing also occurred in this age group. The procedure will not be as beneficial in cases of osteoarthritis of the trapezometacarpal joint or when coverage of the stump is insufficient. The DASH questionnaire is very helpful in evaluating the effect of thumb reconstruction on the entire upper limb.
本回顾性研究的目的是在拇指中节三分之一处创伤性截肢后，通过骨痂牵张和拇指指骨化获得功能结果。
1998年1月至2001年6月，12例患者接受了分期手术，首先进行皮质切开术，然后使用单侧外固定器对第一掌骨进行持续牵张（每天1毫米）。牵张至第31天（范围25 - 35天）后，用钢板固定第一掌骨，并进行指骨化。结果：术后1年随访时，除1例患者外，所有患者的拇指均延长了25 - 35毫米（平均28毫米）。1例患者不得不植入取自髂嵴的骨块。捏力提高了45%；握力提高了55%。DASH问卷的功能/症状评分为25分（范围16 - 38分）。在“拿起测试”中，所有患者都能拿起铅笔，能够写字并能握住一满杯水。9例患者能拿起回形针，8例患者能握住1升装的水瓶。
骨痂牵张可被视为重建中节三分之一处截肢拇指的合适方法。额外的指骨化被证明至关重要，因为它加深了第一掌指关节间隙，实现了良好的活动和抓握功能。老年患者骨痂形成延迟，但该年龄组也实现了足够的延长和骨愈合。在大多角掌骨关节骨关节炎或残端覆盖不足的情况下，该手术效果不佳。DASH问卷在评估拇指重建对整个上肢的影响方面非常有帮助。
