Cansü Eren, Ünal Mehmet Bekir, Parmaksızoğlu Fatih, Gürcan Serkan
Marmara University Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
Medipol University Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2015;49(3):227-32. doi: 10.3944/AOTT.2015.14.0292.
Thumb amputation is a major cause of hand dysfunction, and the treatment for distal thumb amputations remains controversial. Although finger reconstruction methods using distraction lengthening are known to restore finger length and function, we found no reports in the literature regarding phalangeal lengthening in thumb amputations. We aimed to evaluate proximal phalangeal lengthening in thumb amputations at or near the interphalangeal (IP) joint.
We retrospectively evaluated patients who had undergone distraction lengthening of the proximal phalanx of the thumb. All patients underwent osteotomy, either during the initial procedure or as a second-stage procedure. Distraction began 10 days after osteotomy with the use of an external fixator that remained in place until ossification of the gap occurred without bone grafting. Patients were evaluated using the QuickDASH score.
Fourteen patients with a mean age of 27 years and a mean follow-up period of 7 years were enrolled. The mean phalangeal lengthening achieved was 20 mm. Ossification occurred at all distraction sites, and the fixators were maintained for a mean of 85 days. The mean healing index was 42.5 days/cm. All 14 patients achieved the desired amount of phalangeal lengthening without major complications such as nonunion, premature union, or gross infection.
For reconstruction in cases of distal thumb amputations, distraction lengthening of the proximal phalanx can be used to improve absolute length, web space, and grip distance. The technique is safe and effective, improves functionality/cosmesis, and offers a low complication risk.
拇指截肢是手部功能障碍的主要原因，而远节拇指截肢的治疗仍存在争议。尽管已知使用牵张延长的手指重建方法可恢复手指长度和功能，但我们在文献中未发现关于拇指截肢时指骨延长的报道。我们旨在评估指间（IP）关节处或其附近拇指截肢时近节指骨的延长情况。
我们回顾性评估了接受拇指近节指骨牵张延长的患者。所有患者均在初次手术时或作为二期手术进行了截骨术。截骨术后10天开始使用外固定器进行牵张，直至间隙骨化且未进行骨移植时外固定器才移除。使用QuickDASH评分对患者进行评估。
纳入了14例患者，平均年龄27岁，平均随访期7年。平均指骨延长长度为20毫米。所有牵张部位均发生了骨化，外固定器平均保留85天。平均愈合指数为42.5天/厘米。所有14例患者均实现了预期的指骨延长量，且未出现不愈合、过早愈合或严重感染等主要并发症。
对于远节拇指截肢的重建，近节指骨牵张延长可用于改善绝对长度、虎口间距和握距。该技术安全有效，可改善功能/美观，且并发症风险低。
