The Anatomical Measurement And Clinical Studies Of Full-length Finger Reconstruction

BackgroundWith the acceleration of the process of social mechanization,tThe severity of high energy hand injury and the severity of the damage are increasing,the defect of the thumb and finger is one of the most common hand injuries in the clinic,and it has done a big deal of bad effect to patients even in physicalor mental health.With the development of the microsurgical technique,there are many ways to reconstruct the thumb and fingers,With different degrees of finger defect,there are different ways to repair it,However,people have higher requirements for the shape and function of the reconstructed finger.The precision design of finger reengineering is not scientific and normative at present,and it is more inclined to the influence of visual measurement,personal experience,habit and so on.Especially for the defect of the thumb with the metacarpal bone and the reconstruction of the proximal defect of the finger,although there are many ways of operation,it is difficult to achieve the ideal degree of function and shape.ObjectiveThe related anatomical measurements of the finger length,the length of the palm of the finger,the length of the phalanges,the metacarpophalangeal joint and the metatarsophalangeal joint of normal adults,we can get the normal range of each index and the correlation between them.Measurement of human fingers to provide a morphological basis for a standard operation plan and the anatomic data for hand surgery.To explore the surgical technique and its possibility of the second toe and composite tissues with the metatarsal in thumbs and fingers reconstruction,and analyze the clinical treatment outcome.Methods1.The measurement of the length of finger and the length of the palm of the finger by direct measurement on 100 norma Chinese adult aged 19-35(50mal,50female).According to a unified X-ray shooting standard,shooting qualified right-hand X-ray films under the same condition(the direction of projection,the distance of thetarget,the voltage,the current,the exposure time and so on),the magnification is approximately equal to 1.04%.64 rows of spiral CT scans of hand and foot under the same condition on 34 normal chinese adult aged 19-35(17male,17femal),Under thesame conditions(voltage was 120 kv,Electric current was 200,Collimation was 3 mm,Pitch was1.5: 1 and 2mm reconstruction interval and so on).Reconstructing the image after the collection of images to a computer workstation.The images of theaxis,coronal and sagittal position can be obtained by rotating the images according to the needs,and the data related to the metacarpophalangeal joints and metatarsophalangeal joints are measured directly.The measured data were statistically analyzed by SPSS19.0 statistics software.2.9 cases of severe defect of thumb and finger from June 2014 to December 2017.Anatomic data of both hands and feet of the patient before operation.6 cases of thumb were repaired through the big toe wrap-around flap with the second toe and the metatarsal,1 cases of thumb and 2 cases of fingers were repaired through the second toes complex tissue with metatarsal bone.Two methods were used to deal with metatarsophalangeal joints,the metatarsal head was truncated nearby the metatarsophalangeal joint,and the metatarsal head was turned forward 70-80 degree from the dorsal side to the plantar side,then recombinated the metatarsal after dealed with the fracture,so it can rebuild the metacarpophalangeal joints and the metacarpal.For children,we took the form of the intra-articular osteotomy,This is beneficial to the growth of children.All cases were followed up,the follow-up contents included the shape,two-point discrimination,thumb opposition function,metacarpophalangeal joint activity,satisfaction of patients and the shape and function of foot donor site and so on.Results1.We got the minimum and maximum,the average and the standard deviation of the phalange and the metacarpophalangeal joint and the metatarsophalangeal joint on right hands and foots of males and females.2.All cases survived,they were followed up duing 4 to 24 months after operation.The shape was similar with uninjured sides and the two-point discrimination was 1.0-2.0cm.The function recovered satisfactorily and the maximum flexion of the metacarpophalangeal joints can reach 50 degrees,at the same time,it has the function of dorsiflexion.1 cases of fracture healing were unsatisfactory,but the function recovered well after the repair of bone graft.A total of 3 cases were reconstructed,two cases had poor function recovery due to tendon adhesion and scar contracture and no tendon surgery has been done,1 cases of fracture were healed by bone graft.The donor foot has no ulceration,and walking without the pain and lameness.According to the Upper Extremity Functional functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association,there were excellent in 3 cases and good in 4 cases and bad in2 cases.ConclusionsMeasurement of human fingers and toes,and their normal range and correlation were statistically analyzed,It enriches the morphological basis and provides theoretical support for the reconstruction and repair of the thumb and finger.(1)It is feasible to take the second toe composite tissue with metatarsal bone to repair the thumb and finger of severe defect,It not only solved the problem of the short finger,but also improved the function of the metacarpophalangeal joint.(2)The method of intra-articular osteotomy with the preservation of the epiphysis,It can not only improve the function of the finger,but also protect the blood and epiphysis of the metatarsal bone,which is more beneficial to the growth and development of children.