Preisser P, Rudolf K, Partecke B D
BG-Unfallkrankenhaus, Bergedorfer Straße 10, D-21033, Hamburg.
Oper Orthop Traumatol. 1997 Jun;9(2):150-61. doi: 10.1007/s00064-006-0022-8.
Reconstruction of the amputated thumb through continuous distraction with an Ilizarov ring fixator.
Traumatic loss of thumb at the level of the proximal half of the proximal phalanx.
Insufficient soft tissue coverage of stump. Stiff saddle joint.
Tourniquet. Brachial plexus or general anaesthesia.
Installation of a ring fixator. Incomplete osteotomy at mid shaft of first metacarpus with chisel and completion through osteoclasia by twisting the chisel. Preserve palmar periosteum. Deepening of first web space if necessary after removal of external fixator. Use of Z-plasty and proximal transfer of adductor pollicis insertion.
After 1 week continuous lengthening 0.7 mm/day in 3 daily increments. After removal of fixator plaster cast for 2 weeks.
Improper installation of fixator. Incomplete osteotomy. Too rapid or too slow distraction. Pin tract infection. Deep infection.
Over a 2 year period 10 lengthenings. Average follow-up 23 months (10 to 36 months). Average gain in length 38.1 mm. Average length of treatment 163 days. Deepening of web space in 7 patients. Force of grasp 64% of opposite side. Pin tract infection: 4, too early removal of fixator: 1, revision of scar: 1 and correction of stump: 1. All patients were satisfied with the result but for scar at web space.
使用伊里扎洛夫环形固定器通过持续牵引重建拇指截肢。
拇指在近节指骨近端一半水平的创伤性缺失。
残端软组织覆盖不足。鞍状关节僵硬。
使用止血带。臂丛神经麻醉或全身麻醉。
安装环形固定器。用凿子在第一掌骨中段进行不完全截骨，通过扭转凿子经骨破坏完成截骨。保留掌侧骨膜。拆除外固定器后如有必要加深第一掌蹼间隙。使用Z形皮瓣和内收拇肌止点近端转移。
1周后开始持续牵引，每天0.7毫米，分3次进行。拆除固定器后用石膏固定2周。
固定器安装不当。截骨不完全。牵引过快或过慢。针道感染。深部感染。
在2年期间进行了10次延长手术。平均随访23个月（10至36个月）。平均延长长度38.1毫米。平均治疗时间163天。7例患者掌蹼间隙加深。握力为对侧的64%。针道感染4例，固定器拆除过早1例，瘢痕修复1例，残端矫正1例。除掌蹼间隙瘢痕外，所有患者对结果均满意。
