Department of Hand and Microsurgery, Tampere University Hospital, Tampere Finland.
Semin Plast Surg. 2008 Aug;22(3):195-212. doi: 10.1055/s-2008-1081403.
The relatively new concept and technique of microvascular joint transplantation for the correction of the congenitally deformed wrist is presented with a series of 24 operated radial club hands. The results from the 19 upper extremities with a mean follow-up of 11 years show that the new technique will not diminish the longitudinal growth of the ulna. The ulna length in the series is now 15.4 cm in mean and will develop further and presumably better than that reported in the previous long-term studies after centralization. The superiority in wrist active mobility compared with those of some previous long-term studies is reported with total active motion of 83 degrees in mean. The radial deviation deformity has become increased by 12 degrees in mean in the long-term follow-up compared with the results reported previously by the same author in the series of the first nine patients in 1998. The balance in the growth between the supporting metatarsal joint and the distal ulna has remained satisfactory, and the resting radial deviation angle is 28 degrees in mean (range, 0 to 45 degrees) in the cases with successful joint transfer. A subluxation tendency in six of the transplanted joints is a new finding, and its prevention needs careful attention during the reconstruction. With respect to timing, the joint alignment and transplantation procedure is best performed between the ages of 2.5 and 4 years according to the current experience of the author. A pollicization is usually added after the wrist alignment procedure. This technique will give the child a period of ~10 years without any new need for surgical treatment, and usually no splinting is needed during that period. However, an additional corrective osteotomy may be needed at early puberty depending on the growth properties of the joint graft and original ulna and because of ulnar bowing. The reported technique with preoperative and postoperative measures takes a period of about one-half year, and the whole procedure is considered quite demanding as far as an adequate preoperative soft tissue distraction and the microvascular joint transplantation are concerned. It is recommended that the treatment be performed in dedicated microsurgical centers with adequate pediatric tissue transfer experience.
提出了一种用于矫正先天性畸形手腕的微血管关节移植的新概念和新技术，对 24 例桡骨楔形手进行了系列手术。对 19 例上肢进行了平均 11 年的随访，结果表明，新技术不会减少尺骨的纵向生长。该系列中尺骨的平均长度现为 15.4 厘米，并且将进一步发育，并且可能比中心化后的先前长期研究中报告的更好。与一些先前的长期研究相比，报告了手腕主动活动度的优势，平均总主动运动度为 83 度。与作者在 1998 年首次 9 例患者系列中报告的结果相比，长期随访中桡偏畸形平均增加了 12 度。支撑跖骨关节和远端尺骨之间的生长平衡保持满意，成功关节移植的病例平均休息时桡偏角为 28 度（范围 0 至 45 度）。六个移植关节的半脱位趋势是一个新发现，需要在重建过程中小心注意预防。关于时机，根据作者目前的经验，关节对线和移植程序最好在 2.5 至 4 岁之间进行。手腕对线程序后通常会进行拇指化。这种技术将使孩子在 10 年左右的时间内无需任何新的手术治疗，通常在这段时间内不需要夹板固定。然而，根据关节移植物和原始尺骨的生长特性以及尺骨弯曲，可能需要在早期青春期进行额外的矫正性截骨术。报告的技术包括术前和术后措施，大约需要半年的时间，整个过程被认为是相当具有挑战性的，因为需要充分的术前软组织牵张和微血管关节移植。建议在有足够小儿组织转移经验的专门显微外科中心进行治疗。
