School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
J Hand Surg Am. 2020 Jan;45(1):64.e1-64.e8. doi: 10.1016/j.jhsa.2019.03.010. Epub 2019 May 7.
To study the bone resorption pattern of iliac crest grafts after thumb reconstruction with a wrap-around flap from the hallux.
Patients who underwent thumb reconstruction with a wrap-around flap from the hallux were followed up. We measured the length, proximal, middle, and distal widths, and proximal, middle, and distal thicknesses of the iliac crest grafts on posteroanterior and lateral radiographs and used the length, width, and thickness ratios of the iliac grafts and the first metacarpal bones to calculate the amount of bone resorption. Data from 2 groups reconstructed with or without a terminal tuft were analyzed.
Fifteen patients were followed for an average of 20 months (range, 14-72 months). Bone resorption occurred in all 3 measured dimensions in all patients and the degree of resorption increased with time. Resorption amounts of the length dimension in the group with a terminal tuft was significantly decreased compared with those in the group without a terminal tuft at 6 months, 12 months, and the last follow-up. The resorption amount of the width dimension of the distal portion was significantly less in the group with a terminal tuft at the last follow-up. The resorption amount of the thickness dimension of the distal portion was significantly lower in the group with a terminal tuft at 12 months and at the last follow-up.
Bone resorption occurred in all dimensions of the graft after thumb reconstruction using a wrap-around flap from the hallux. Flaps including the terminal tuft had less bone resorption in the distal portion. Wrap-around toe flaps should only be used in cases of thumb amputations at the middle of the proximal phalanx and distal, and the terminal tuft should be preserved in the flap; fixation with a plate should be avoided.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
研究从踇趾环绕皮瓣重建拇指后髂嵴移植物的骨吸收模式。
随访接受从踇趾环绕皮瓣重建拇指的患者。我们测量了髂嵴移植物的前后位和侧位 X 线片上的长度、近段、中段和远段宽度以及近段、中段和远段厚度，并使用髂骨移植物和第一掌骨的长度、宽度和厚度比来计算骨吸收量。分析了有或没有终末束的两组数据。
15 例患者平均随访 20 个月（范围 14-72 个月）。所有患者在所有 3 个测量维度均发生骨吸收，且吸收程度随时间增加。有终末束的组在 6 个月、12 个月和最后一次随访时，长度维度的吸收量明显低于无终末束的组。有终末束的组在最后一次随访时远段宽度维度的吸收量明显较少。有终末束的组在 12 个月和最后一次随访时远段厚度维度的吸收量明显较低。
从踇趾环绕皮瓣重建拇指后，移植物所有维度均发生骨吸收。包含终末束的皮瓣在远段的骨吸收较少。环绕趾皮瓣仅应用于近节和远节指骨中段的拇指截肢，皮瓣中应保留终末束；应避免用钢板固定。
研究类型/证据水平：治疗性 IV 级。
