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采用第二趾移植治疗一名4岁儿童创伤性拇指截肢：病例报告

Transfer of Second Toe for the Treatment of Traumatic Thumb Amputation in a Four-year-old Child: A Case Report.

作者信息

Nakamoto Hugo Alberto, Gonçalves Reinaldo Borges, Nakamoto João Carlos, Iwase Fernanda do Carmo, Pessa Mariana Miranda Nicolosi, Rezende Marcelo Rosa de

机构信息

Grupo de Cirurgia da Mão e Microcirurgia, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas (HC), Faculdade de Medicina (FM), Universidade de São Paulo (USP), São Paulo, SP, Brasil.

出版信息

Rev Bras Ortop (Sao Paulo). 2022 May 31;59(4):e632-e636. doi: 10.1055/s-0042-1744518. eCollection 2024 Aug.

DOI:10.1055/s-0042-1744518
PMID:39239593
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11374401/
Abstract

Microsurgical toe transfer for thumb reconstruction is a challenging procedure, considering the technical skills necessary to perform it, as well as the difficult postoperative evaluation of esthetical and functional aspects. The present is the report of the case of a 3-year-old child who suffered a traumatic thumb amputation. Thumb reconstruction was performed through microsurgical toe transfer months after replantation failure. Subjective and objective outcome assessments were performed five years after the procedure. The functional outcome was evaluated through the Childhood Health Assessment Questionnaire (CHAQ) and the Jebsen-Taylor Hand Function Test (JTHFT). The Jamar dynamometer (Sammons Preston, Bolingbrook, IL, US) and the Jamar Pinch Gauge (Sammons Preston) devices were used to assess the handgrip and pinch strength respectively. The Semmes-Weinstein monofilament and two-point discrimination tests were performed. The patient presented an excellent functional outcome, partial recovery of strength, complete sensory recovery, and minimal donor site morbidity. A radiographic evaluation was also performed, and it demonstrated the preservation of the epiphyseal plate and the growth potential of the transplanted toe. In all aspects, the data observed reinforce the benefits and indications of toe transfer for thumb reconstruction in children.

摘要

考虑到进行显微外科脚趾移植重建拇指手术所需的技术技能以及术后美学和功能方面的困难评估，这是一个具有挑战性的手术。本文报告了一名3岁儿童拇指外伤性截肢的病例。在再植失败数月后，通过显微外科脚趾移植进行了拇指重建。术后五年进行了主观和客观结果评估。通过儿童健康评估问卷（CHAQ）和杰布森 - 泰勒手部功能测试（JTHFT）评估功能结果。分别使用Jamar握力计（美国伊利诺伊州博林布鲁克市Sammons Preston公司）和Jamar捏力计（Sammons Preston公司）评估握力和捏力。进行了Semmes - Weinstein单丝试验和两点辨别试验。患者呈现出优异的功能结果、力量部分恢复、感觉完全恢复以及供区并发症极少。还进行了影像学评估，结果显示移植脚趾的骨骺板得以保留且具有生长潜力。在各个方面，观察到的数据都进一步证明了儿童拇指重建中脚趾移植的益处和适应症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0a5a/11374401/86e591ae1fe6/10-1055-s-0042-1744518-i2000413pt-5.jpg
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Evaluation of pediatric upper extremity peripheral nerve injuries.小儿上肢周围神经损伤的评估
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