Ishida O, Tsai T M
Christine M. Kleinert Institute for Hand and Micro Surgery, Louisville, KY 40202.
Microsurgery. 1991;12(3):196-206. doi: 10.1002/micr.1920120309.
Reconstruction of the traumatized finger joint with epiphyseal destruction has long been problematic. Since free vascularized whole joint transfer was introduced as a treatment for joint and epiphyseal destruction, this procedure has been selected as an alternative treatment because it may provide a growing epiphysis. We have reviewed our series of 19 joint transfers. Mean age at operation was 6.2 years (range 3 to 12). Average active range of motion was 31 degrees/61 degrees for the group with posttraumatic reconstruction (n = 12) and 21 degrees/43 degrees for the group with reconstruction of a congenital deformity (n = 7), with an overall average of 27 degrees/54 degrees. Average range of motion following transfer of an metatarsophalangeal (MTP) or metacarpophalangeal (MCP) joint to an MCP joint position was 39 degrees/75 degrees (n = 4); proximal interphalangeal (PIP) to PIP transfer was 22 degrees/39 degrees (n = 13); and PIP to MCP transfer was 38 degrees/51 degrees (n = 2). The proximal phalanges in MCP joints transferred to the MCP position grew an average of 7.0 mm, and the middle phalanges of joints transferred to the PIP position grew 4.3 mm. Almost normal growth was observed in all transferred joints except two that showed premature epiphyseal closure. Indications for this procedure and techniques to improve range of motion are described.
伴有骨骺破坏的创伤性手指关节重建一直是个难题。自从采用游离带血管蒂全关节移植来治疗关节和骨骺破坏以来，该手术已被选作一种替代治疗方法，因为它可能提供一个生长中的骨骺。我们回顾了我们的19例关节移植系列病例。手术时的平均年龄为6.2岁（范围3至12岁）。创伤后重建组（n = 12）的平均主动活动范围为31度/61度，先天性畸形重建组（n = 7）为21度/43度，总体平均为27度/54度。将跖趾（MTP）或掌指（MCP）关节转移至MCP关节位置后的平均活动范围为39度/75度（n = 4）；近端指间（PIP）关节至PIP关节转移为22度/39度（n = 13）；PIP关节至MCP关节转移为38度/51度（n = 2）。转移至MCP关节位置的MCP关节中的近端指骨平均生长了7.0毫米，转移至PIP关节位置的关节中的中指骨生长了4.3毫米。除了两个出现骨骺过早闭合的关节外，在所有移植关节中均观察到几乎正常的生长。本文描述了该手术的适应证以及改善活动范围的技术。
