School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, 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. 2024 Jun;49(6):607.e1-607.e7. doi: 10.1016/j.jhsa.2022.06.027. Epub 2022 Aug 26.
This study aimed to evaluate the radiological and functional results of secondary thumb reconstruction via ectopic banking of bony phalanges from a nonreplantable amputated thumb.
Thumb reconstruction was performed using the bony phalanges from a nonreplantable amputated thumb that were ectopically banked in a subcutaneous pocket. A wraparound flap was harvested from the ipsilateral great toe and wrapped around the bone graft. After surgery, the results were assessed in terms of infection, range of motion, bone union of the graft, and signs of osseous resorption of the reconstructed thumb.
Fifteen patients underwent secondary thumb reconstruction using this technique between January 2003 and October 2018. Ten patients were followed up for at least 6 months (6 months to 9 years) and were included in this study. All wraparound flap transfers were viable. No bone graft infection was observed. In the 6 cases in whom the interphalangeal joint was not fused, the interphalangeal joint motion ranged from 5° to 60° with an average of 35.0° ± 15.1°. The metacarpophalangeal joint motion ranged from 5° to 66°, with an average range of motion of 48.2° ± 23.6° for the cases in whom the joint was not fused. In 8 of the 10 patients, the time of bone ectopic banking was within 10 days. In these patients, bone union with no osseous atrophy was observed. In 2 patients whose phalanx was banked for more than a month, different degrees of bone resorption of the grafted phalanx were evident after transplantation, although no further treatment was required.
Bony phalanges from a nonreplantable amputated thumb can be ectopically banked and used for secondary reconstruction of the thumb. The duration of banking before thumb reconstruction should be no more than 2 weeks.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
本研究旨在评估通过异位保存非再植性断指的骨性指骨来进行继发性拇指再造的放射学和功能结果。
通过将异位保存在皮下囊中的非再植性断指的骨性指骨进行拇指再造。从同侧大脚趾切取环绕皮瓣，包裹在移植物周围。手术后，根据感染、运动范围、移植物骨愈合以及再造拇指的骨吸收迹象来评估结果。
2003 年 1 月至 2018 年 10 月期间，15 例患者采用该技术进行继发性拇指再造。10 例患者随访至少 6 个月（6 个月至 9 年），并纳入本研究。所有环绕皮瓣转移均存活。未观察到骨移植物感染。在未融合指间关节的 6 例中，指间关节活动度为 5°至 60°，平均 35.0°±15.1°。掌指关节活动度为 5°至 66°，指间关节未融合的病例平均活动度为 48.2°±23.6°。在 10 例患者中有 8 例的异位骨库时间在 10 天内。这些患者观察到骨愈合而无骨萎缩。在 2 例将指骨库存在 1 个月以上的患者中，尽管不需要进一步治疗，但移植后可见移植物骨的不同程度吸收。
非再植性断指的骨性指骨可以异位保存并用于继发性拇指再造。拇指重建前的保存时间应不超过 2 周。
研究类型/证据水平：治疗性 V 类。
