- 期刊
Vascularized Joint Transfers from Amputation Stumps without a Functioning Length
由未達功能性長度之手指殘肢截取游離關節移植
摘要
背景：當手部多指受到嚴重的壓砸傷時，我們可以運用異指移植的方法把可以被挽救的斷肢重植到功能上較重要的手部位置處。根據「備用零件（spare part）」的原理，Hattori將一根無法重植的斷指上的關節經由顯微手術的方式移植，重建一隻受到複雜性傷害的手。目的及目標：在本次報導當中，我們評估從一隻因截肢而無法達到功能性長度的手指斷肢端處，截取其未受傷的近指關節做關節移植。材料及方法：這是一位48歲的男性患者，個案左手遭受二到五指電鋸傷，其中無名指在近指間關節有一複合性缺損；其小指截肢因組織缺損而不適合重植，但其近指間關節卻完好。重建時，我們將其小指的近指間關節由其殘肢端擷取，移植至無名指之近指間關節。病人術後接受規則性手部復健，於術後六個月時有接受過肌腱鬆弛手術，術後總共追蹤了24個月。結果：最後追蹤時，被移植的近指間關節主動性活動達到75°（25°/100°）。追蹤兩年期間移植關節並未發生關節退化之病變。結論：手術時如果直接幫無名指的近指間關節作關節固定手術，勢必會造成無名指變短，而且也無彎曲之功能。從腳趾移植關節可能是另一種選項，但並不是所有的病人都願意接受這樣的移植。然而原本小指截肢後的長度無法達到功能性的長度，因此這樣從殘肢端擷取的近指間關節的移植並未特別犧牲掉原本小指的功能；當然，更長時間的追蹤是有必要的。
關鍵字
無資料並列摘要
Background:Multi-digital mutilation is a devastating injury causing malfunction of a global hand. Heterodigital transplantation during replantation was applied to replant the salvageable amputees to the digits with more important function. Based on ”spare Part” concept, Hattori transferred a vascularized joint from a non-replantable digit for primary reconstruction of complex hand injury.Aim and Objectives:In this study, we evaluated a heterodigital transplantation of a vascularized joint from an amputated stump without a functioning length.Materials and Methods:A 48-years male injured his left hand by a power saw, involving the middle phalanges of index to small fingers. The soft tissue of the ring finger was severely damaged along with destruction of the PIP joint. The small finger was amputated with bone and soft tissue loss, which made the replantation of the small finger unrealistic. A vascularized PIP joint was transferred from the amputation stump of small finger to the ring finger. Subsequent tenolysis was performed in six months. The patient received regular rehabilitation and was followed for 24 months.Results:The final active ROM of the transferred PIP joint was 75° (25°/100°). No arthrosis of the transferred joint was identified at the final follow-up.Conclusion:The PIP joint transfer from the amputation stump did not sacrifice the function of the small finger, of which the functioning length could not be preserved. Arthrodesis of the PIP joint of ring finger might decrease the length of the finger, and the motion was sacrificed. Vascularized joint transfer from the toe was another option, but the donor site morbidity may not be preferred by every patient.
延伸閱讀
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