Langlais F, Renaud B, Fourastier J
Rennes Urgences Mains (Service de Chirurgie Orthopédique et Réparatrice), CHU Pontchaillou.
Rev Chir Orthop Reparatrice Appar Mot. 1993;79(5):385-92.
Fifteen pollicisations of undamaged ring fingers were carried out after isolated thumb amputations, occurring most of the time above the MP in manual workers. All these patients were re-examined with a minimum two years' follow-up and an average 5 years'. There was no complication, and all the patients operated on resumed an active work at the fifth postoperative month on average. Early rehabilitation was favoured by bone fixation of the first metacarpal with an intramedullary peg, and by careful cinematisation (reinsertion of all extensors, cinematisation by the flexor pollicis longus). The results showed that this procedure was the surgery of choice for isolated amputations of the thumb occurring in manual workers at the level of or above the MP. Indeed, if it is compared with transfers of the 2nd toe, pollicisation is characterized by its reliability, an early return to work, a greater range of active motion (60 degrees instead of 30 degrees), pulp-pinch and key-pinch figures at 54 per cent, a hand-grasp (70 per cent) identical or better, a touch sensibility two or three times as good (Weber at 5 mm), a better cold tolerance (no professional disability), and by the fact that there is no discomfort at the level where the transplanted digit was removed.
在孤立性拇指截肢后，对15例未受损的环指进行了拇指化手术，大多数情况发生在体力劳动者的掌指关节以上水平。所有这些患者均进行了复查，随访时间最短为2年，平均为5年。无并发症发生，所有接受手术的患者术后平均在第5个月恢复了积极的工作。第一掌骨用髓内钉固定以及仔细的肌腱移位术（所有伸肌腱重新插入，由拇长屈肌进行肌腱移位）有利于早期康复。结果表明，对于体力劳动者在掌指关节或其以上水平发生的孤立性拇指截肢，该手术是首选手术。实际上，如果将其与第二趾移植相比较，拇指化的特点是可靠性高、早期恢复工作、主动活动范围更大（60度而非30度）、捏物和钥匙捏物指数为54%、手握力（70%）相同或更好、触觉敏感度好两到三倍（5毫米处的韦伯试验）、耐寒性更好（无职业残疾），并且在移植手指移除部位没有不适感。
