探讨自体关节移植修复外伤性掌指关节缺损伤的临床应用效果。

选择2007年6月至2020年1月深圳市中西医结合医院骨伤科收治的外伤性掌指关节缺损伤患者15例。术前患者完善各项常规检查，行患侧手及关节移植供足直接数字化X射线摄影系统检查，改善患者全身营养状况，纠正低蛋白血症和贫血；围手术期严禁吸烟，术前进行床上大、小便训练；亚急诊期患者行创面分泌物培养排除创面感染；二期手术患者术前用延长支架将待移植的关节延长到合适的关节移植间隙。术中对受区清创，止血，探查骨关节、伸屈肌腱、指血管和指神经损伤情况及关节皮肤缺损情况，测量骨关节缺损长度。根据患者受伤情况选择应用自体第2跖趾关节游离移植、自体废弃指的掌指关节移植修复、自体腕掌关节半关节移植修复3种方法进行修复。术后绝对卧床1周，绝对禁烟，保温灯保温；予抗感染、抗血管痉挛、抗凝血、全身支持等治疗；术后2周拆线，逐步进行康复训练，定期拍X线片检查骨愈合情况，骨愈合后拆除克氏针。术后1周对移植关节及携带的皮瓣和患指的血运情况进行观察，并观察是否出现血管危象；术后2周观察创面愈合情况；术后12周观察移植关节的骨愈合情况；术后门诊随访6~24个月，观察患者手功能恢复情况。

本组15例外伤性掌指关节缺损伤全部修复良好，术后移植的关节及携带的皮瓣均成活良好，修复的患指血运良好，皮瓣及患指均未发生血管危象，全部创面均甲级愈合。术后随访平均(14.5±4.6)个月，移植关节的骨接合端均有连续性骨痂通过，骨性愈合，局部无压痛、无纵行叩击痛、无异常活动。移植的掌指关节活动度：背伸0~10°，屈曲60°~90°(平均75°)。手功能恢复评价优10例，良5例，优良率为100%。

自体关节移植修复外伤性掌指关节缺损伤，可良好恢复患指的掌指关节功能，保留患指的完整性，疗效满意。

To investigate the clinical effect of autologous joint transplantation in the repair of traumatic metacarpophalangeal joint defect.

From June 2007 to January 2020, 15 patients with traumatic metacarpophalangeal joint defect treated in the Department of Orthopedics and Traumatology of Shenzhen Integrated Traditional Chinese and Western Medicine Hospital were selected. Before the operation, the patient were completed various routine examinations, and performed direct digital X-ray photography system inspections of the affected hand and joint transplantation, improved the patient′s overall nutritional status and corrected the hypoproteinemia and anemia. Smoking was strictly prohibited during the perioperative period, and bed-sized and urinary training was performed before the operation; wound secretion culture was performed to eliminate wound infection in patients in the sub-emergency period; the joint to be transplanted was extended to a suitable joint transplantation space with an extension stent before the second-stage operation. During the operation, debridement of the affected area was carried out, hemostasis was performed, injury of the digital blood vessels and nerve of the extensor tendon of the bone joint and skin defect of the joint were investigated, and the length of the defect of the bone joint was measured. According to the injury situation of the patients, three methods were used to repair the injury: free transplantation of the second metatarsophalangeal joint, metacarpophalangeal joint transplantation of the abandoned finger and half joint transplantation of the metacarpophalangeal joint. After the operation, the patient stayed in bed absolutely for 1 week, absolutely non-smoking, and kept warm with heat preservation lamp; the patient was treated with anti-infection, anti-vasospasm, anti-coagulation, and systemic support. The stitches were removed 2 weeks after the operation, and rehabilitation training was gradually carried out. The X-ray was taken to check the bone healing on a regular basis, and the Kirschner wire was removed after the bone was healed. The blood flow of grafted joints and carried flaps and affected finger was observed 1 week after operation, and observed whether there was vascular crisis; the wound healing was observed 2 weeks after surgery; the bone healing condition of transplanted joint was observed 12 weeks after operation. The postoperative outpatient follow-up was 6 to 24 months to observe the recovery of the patient′s hand function.

All 15 cases of metacarpophalangeal joint defects were well repaired, the transplanted joints and skin flaps survived well, the blood supply of the repaired fingers was good and no vascular crisis occurred in the flaps and affected fingers, all wounds healed in grade A. The average postoperative follow-up was (14.5±4.6) months. There was continuous callus passing through the bone junction of the transplanted joint, bone healed, and there was no local tenderness, no longitudinal percussion pain, and no abnormal movement. The range of motion of the transplanted metacarpophalangeal joint: dorsal extension 0 to 10°, flexion 60° to 90° (average 75°). In the evaluation of hand function recovery, 10 cases were excellent and 5 cases were good, the excellent and good rate was 100%.

Autogenous joint transplantation for the repair of traumatic metacarpophalangeal joint injury can well restore the metacarpophalangeal joint function of the affected finger, preserve the integrity of the affected finger, and have a satisfactory effect.