本文選題：拇指 + 缺損��； 參考：《蘇州大學(xué)》2015年碩士論文

【摘要】：目的:探討足部瓦合皮瓣聯(lián)合植骨再造拇指的手術(shù)方法和臨床療效。方法:對14例拇指不同程度缺損的患者,采用足部瓦合皮瓣聯(lián)合髂骨植骨再造。采用同蒂趾甲皮瓣與第二趾脛側(cè)皮瓣瓦合再造拇指末節(jié)缺損5例,采用雙蒂趾甲皮瓣與第二趾脛側(cè)皮瓣瓦合再造拇指末節(jié)缺損4例,采用同蒂趾甲皮瓣與足背動脈皮瓣瓦合再造拇指近節(jié)缺損3例,采用雙蒂趾甲皮瓣與足背動脈皮瓣瓦合再造拇指近節(jié)缺損2例。骨缺損均采用不帶血供的髂骨條移植修復(fù)。結(jié)果:術(shù)后患者傷口均一期愈合,14例再造指均順利成活。1例趾供區(qū)植皮部分壞死,經(jīng)換藥后愈合。術(shù)后8~12周攝X線片,移植骨與拇指骨質(zhì)臨床愈合取出內(nèi)固定。隨訪6~60個月,修復(fù)后的拇指外形接近正常拇指,指甲生長良好,血供好,再造指體指背感覺恢復(fù)S2~S3,指腹感覺恢復(fù)S2~S4。8例保留掌指關(guān)節(jié)者,掌指關(guān)節(jié)活動度為0~70°,接近正常拇指掌指關(guān)節(jié)活動度,4例掌指關(guān)節(jié)、指間關(guān)節(jié)均保留者掌指關(guān)節(jié)活動正常,指間關(guān)節(jié)活動0~80°,接近正常。2例掌指關(guān)節(jié)融合者無關(guān)節(jié)活動度。14例均可以完成對指、對掌功能。隨訪期內(nèi)未出現(xiàn)骨不愈合及移植骨吸收的現(xiàn)象。按照中華醫(yī)學(xué)會拇、手指再造功能評價標(biāo)準(zhǔn)評定,屬優(yōu)者11例,良者3例。足部供區(qū)植皮愈合滿意,無明顯的瘢痕攣縮及破潰現(xiàn)象,不影響患者行走。髂部供區(qū)線狀瘢痕愈合,無觸痛等不適感�；颊咦晕腋杏X均滿意。結(jié)論:利用足部瓦合皮瓣聯(lián)合植骨再造拇指可以恢復(fù)拇指的良好外形,供足足趾個數(shù)不減少,是一種較好的方法。
[Abstract]:Objective: to investigate the operative method and clinical effect of foot flap combined with bone graft for thumb reconstruction. Methods: 14 patients with different degree of thumb defect were treated with foot flap combined with iliac bone graft. Toe nail flap with the same pedicle and tibial flap with the second toe were used to reconstruct the distal segment of the thumb in 5 cases, and the tibial flap of the second toe and the double pedicle toenail flap were used to reconstruct the defect of the distal segment of the thumb in 4 cases. The proximal thumb defect was reconstructed with pedicle nail flap and dorsal foot artery flap in 3 cases and the proximal thumb defect with double pedicle toe nail flap and dorsal foot artery flap in 2 cases. Bone defects were repaired by iliac bone graft without blood supply. Results: all the patients had primary wound healing and 14 cases of finger reconstruction survived successfully. 1 cases had partial necrosis of skin grafts in toe donor area and healed after dressing change. X-ray films were taken at 812 weeks after operation and internal fixation was taken out after clinical healing of bone graft and thumb. Following up for 6 ~ 60 months, the repaired thumb was close to the normal thumb, the fingernail grew well, the blood supply was good, the dorsal sensation of the reconstructed finger recovered S2S3, and the ventral sensation of the finger recovered S2S4.8 cases of the metacarpophalangeal joint were preserved. The motion of metacarpophalangeal joint was 0 ~ 70 擄. The movement of metacarpophalangeal joint was close to that of normal thumb and metacarpophalangeal joint in 4 cases. The movement of interphalangeal joint was 80 擄, which was close to normal in 2 cases of metacarpophalangeal joint fusion. No bone nonunion and graft resorption occurred during the follow-up period. According to the evaluation standard of thumb and finger reconstruction function of Chinese Medical Association, 11 cases were excellent and 3 cases were good. The skin grafts in the donor area of the foot healed satisfactorily, without obvious scar contracture and rupture, and did not affect the walking of the patients. Iliac donor area linear scar healing, no tenderness and other discomfort. All the patients were satisfied with their self-feeling. Conclusion: it is a good method to restore the good appearance of the thumb by using the pedicle flap combined with bone graft, and the number of the donor toe is not reduced.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R658.3

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