Pfeiffer K M
Abteilung für Hand- und periphere Nervenchirurgie, Universität Basel.
Handchir Mikrochir Plast Chir. 1993 Mar;25(2):80-4.
In complex dorsal injuries of the thumb with an intact CM-joint, the reconstruction of a stable post for grip is of greater importance than restoring mobility to the MP- or IP-joint. The basis of reconstruction is primary stable internal fixation of the fractured bones, in some cases necessitating an arthrodesis or interposition of cortico-cancellous bone grafts. Extensor tendons are repaired or reconstructed if distal joint function is to be expected. In order to prevent neuroma formation, direct nerve repair is favoured, but nerve-grafting is not recommended. In exclusively dorsal lesions, there is usually no need for vascular reconstruction. The main donor areas for coverage of dorsal skin defects by pedicled island flaps are the dorsal forearm and the dorsal aspect of the index finger. Reconstruction of a mobile CM-joint and its motors should always be attempted. A CM-joint fusion is only indicated as a salvage procedure.
在拇指背侧复杂损伤且掌腕关节完整的情况下，重建一个稳定的抓握柱比恢复掌指关节或指间关节的活动度更为重要。重建的基础是对骨折部位进行初步稳定的内固定，在某些情况下需要进行关节融合术或植入皮质松质骨移植片。如果预期远端关节功能良好，则修复或重建伸肌腱。为防止形成神经瘤，首选直接神经修复，但不建议进行神经移植。对于单纯的背侧损伤，通常无需进行血管重建。带蒂岛状皮瓣覆盖背侧皮肤缺损的主要供区是前臂背侧和示指背侧。应始终尝试重建可活动的掌腕关节及其动力装置。掌腕关节融合仅作为挽救手术进行。
