作者：Lin, Chih-Hung M.D.; Lo, Steven M.D.; Lin, Cheng-Hung M.D.; Lin, Yu-Te M.D.
文章發表：Plast Reconstr Surg. 2012 Dec;130(6):810e-818e
大綱
一、背景：掌指關節近端的拇指截肢不可避免伴有魚際肌的破壞和繼發性對立性的喪失。三指捏合是腳趾到拇指重建的基本目標之一。旋前骨轉位術是恢復對掌的傳統方法，但是同時地進行對掌肌腱轉移術可能會將這種靜態變成動態功能。二、方法：從1992年到2010年，19位病人掌指關節處截肢並伴有魚際肌肉損傷，接受腳趾到拇指的轉移。所有患者均行帶蒂腹股溝骨皮瓣（n = 16）或游離骨皮瓣（n = 3）進行截肢殘肢表面置換。九個轉移的腳趾經過30至60度轉位對位骨合成術（第一組）。十個轉移的腳趾同時接受對掌的肌腱轉移（第二組）。三、結果：第一組的百分之七十八（佔九分之七）和第二組的百分之一百達到了對掌的基本手功能和橫向捏。相比之下，第一組中只有33％（九分之三）恢復了三指的捏緊力，而第二組則為90％（九分之九），具有統計學意義（p = 0.02）。四、結論：與骨移位的靜態對掌相比，腳趾移植中同時對掌肌腱轉移術可提供對掌的積極恢復，並能更好地恢復三指的捏合。 因此，建議在這種情況下，在腳趾轉移時進行對掌肌腱轉移術。
BACKGROUND:
Thumb amputations proximal to the metacarpophalangeal joint inevitably result in destruction of the thenar musculature and secondary loss of opposition. Opposable tripod pinch is one of the essential goals in toe-to-thumb reconstruction. Pronation osteosynthesis is the traditional method of restoring opposition, but a simultaneous opponensplasty may turn this static process into a dynamic one.
METHODS:
From 1992 to 2010, 19 toe-to-thumb transfers at and proximal to the metacarpophalangeal level with concomitant thenar muscle damage were examined. All underwent either pedicled groin flap (n = 16) or free flap (n = 3) surgery for amputation stump resurfacing. Nine transferred toes had a static opposition procedure with osteosynthesis by rotation of 30 to 60 degrees (group I). Ten transferred toes underwent an additional simultaneous opponensplasty to provide dynamic opposition (group II).
RESULTS:
Seventy-eight percent (seven of nine) of group I and 100 percent of group II achieved opposable basic hand function and lateral pinch. In contrast, only 33 percent (three of nine) in group I regained tripod pinch grip compared with 90 percent (nine of 10) in group II, which was statistically significant (p = 0.02).
CONCLUSIONS:
Primary opponensplasty in toe transfers provides active restoration of opposition and significantly better restoration of tripod pinch, in comparison with static opposition with osteosynthesis. It is therefore recommended that primary opponensplasty be performed at the time of toe transfer in such injuries.
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