Pillukat Thomas, Kalb Karlheinz, Windolf Joachim, van Schoonhoven Jörg
Rhönklinikum, Klinik für Handchirurgie.
Universitätsklinikum, Düsseldorf Klinik für Unfall- und Handchirurgie.
Handchir Mikrochir Plast Chir. 2018 Feb;50(1):36-43. doi: 10.1055/a-0579-9913. Epub 2018 Mar 28.
The fractured base of the middle phalanx was reconstructed in 13 patients using an osteochondral transplant from the carpometacarpal joint surface of the hamate bone. The goal was to restore joint stability with preservation of mobility. Indications were acute and missed isolated destruction of the palmar middle phalanx base ≥ 30 %. Contraindications were destruction of the head of the proximal phalanx, advanced chondropathy of the head of the proximal phalanx, and extensive soft tissue injury with loss of skin coverage for the proximal interphalangeal joint.
In this procedure the fractured middle phalangeal base was debrided and the defect replaced by a size-matched autograft from the dorsal carpometacarpal osteoarticular surface of the hamate bone, which was secured in place with miniscrews.
Bone fusion was achieved in 100 % with restoration of joint congruity in 12 of 13 cases and a slight subluxation in one case. Follow-up was possible in 9 cases after 23 (5-51) months. The average range of motion in the reconstructed joint for extension/flexion was 0/9/73°; grip strength was 82 % of the unaffected side. Five out of 9 patients developed a mild flexion contracture in the PIP joint. The DASH score was 6 (0-33) points, pain at rest was 1 (0-5), and pain at exercise 2 (0-6) on a visual analogue scale from 0-10. All patients were satisfied and willing to undergo the procedure again. According to the literature, reconstruction of the base of the middle phalanx by an osteochondral graft from the hamate bone is a reliable procedure to restore stability and mobility of the joint.
对13例患者采用来自钩骨掌指关节面的骨软骨移植重建中节指骨骨折基底。目标是在保留活动度的同时恢复关节稳定性。适应证为急性及漏诊的孤立性掌侧中节指骨基底破坏≥30%。禁忌证为近节指骨头破坏、近节指骨头晚期软骨病以及近端指间关节广泛软组织损伤伴皮肤覆盖缺失。
在此手术中，对骨折的中节指骨基底进行清创，并用来自钩骨背侧掌指骨关节面的大小匹配的自体移植物替代缺损，用微型螺钉固定到位。
100%实现骨融合，13例中有12例关节恢复平整，1例有轻度半脱位。9例患者在23（5 - 51）个月后接受随访。重建关节的屈伸平均活动范围为0/9/73°；握力为健侧的82%。9例患者中有5例近端指间关节出现轻度屈曲挛缩。 Disabilities of the Arm, Shoulder and Hand（DASH）评分为6（0 - 33）分，静息痛为1（0 - 5）分，运动痛在0 - 10视觉模拟量表上为2（0 - 6）分。所有患者均满意并愿意再次接受该手术。根据文献，采用来自钩骨的骨软骨移植重建中节指骨基底是恢复关节稳定性和活动度的可靠手术。
