Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, whi...Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, while preserving sensation and aesthetics. Achieving these outcomes can be especially challenging in severe cases of soft tissue and bony loss. The authors present a case of a 20-year-old right-hand dominant female involved in a motor vehicle accident who sustained severe crush injuries and burns to her right hand. Her injuries included soft tissue and bony defects extending from the thumb to the distal radius, namely avulsion of the thumb and significant loss of the distal radial and carpal column, resulting in severe wrist instability. We employed a three-segment vascularized osteocutaneous fibula flap to reconstruct the thumb and wrist to restore bony construct, carpal support, and soft tissue coverage. Thumb motion could not be achieved, but this technique offered a sensate, functional post for opposition and the appearance of an anatomic hand. Because of this surgery, the patient was enabled to graduate from college and pursue full-time employment. The authors hope that this report will add to the fund of knowledge and surgeon armamentarium for similar devastating injuries demanding thumb and wrist reconstruction.展开更多
目的建立一种标准化、可重复、简易的数字化评估方法,精确评估计算机辅助游离腓骨下颌骨重建术后效果。方法通过对20例因肿瘤致下颌骨缺损后行计算机辅助游离腓骨下颌骨重建手术病例的回顾性分析,在Mimics Research 21.0及3-matic Resea...目的建立一种标准化、可重复、简易的数字化评估方法,精确评估计算机辅助游离腓骨下颌骨重建术后效果。方法通过对20例因肿瘤致下颌骨缺损后行计算机辅助游离腓骨下颌骨重建手术病例的回顾性分析,在Mimics Research 21.0及3-matic Research 13.0软件辅助下对重建术前与术后冠状向、矢状向与轴向下颌角进行测量分析,评估计算机辅助游离腓骨下颌骨重建术后效果。结果在计算机辅助游离腓骨下颌骨重建的20例患者中,术前健侧和患侧冠状下颌角、轴向下颌角差异无统计学意义(P>0.05),矢状下颌角差异有统计学意义(P<0.05);术后健侧和患侧冠状、矢状、轴向下颌角差异均无统计学意义(P>0.05)。术前与术后健侧和患侧冠状、矢状、轴向下颌角差值的绝对值差异有统计学意义(P<0.01)。Ⅰ类缺损术前健侧和患侧矢状下颌角、术后健侧和患侧轴向下颌角差异有统计学意义(P<0.05),其余各类缺损术前与术后健侧和患侧三维下颌角差异均无统计学意义(P>0.05)。Ⅰ类缺损术前与术后健侧和患侧矢状、冠状下颌角差值的绝对值差异无统计学意义(P>0.05),其余各类缺损术前与术后健侧和患侧三维下颌角差值的绝对值差异均有统计学意义(P<0.05)。结论计算机辅助游离腓骨下颌骨重建对于肿瘤造成的三维方向的颌骨畸形均有显著的改善,能有效恢复下颌骨解剖结构的精确对称,应用本研究的评估方法能精确地评估下颌骨重建术后效果,为术前的设计提供指导。展开更多
文摘Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, while preserving sensation and aesthetics. Achieving these outcomes can be especially challenging in severe cases of soft tissue and bony loss. The authors present a case of a 20-year-old right-hand dominant female involved in a motor vehicle accident who sustained severe crush injuries and burns to her right hand. Her injuries included soft tissue and bony defects extending from the thumb to the distal radius, namely avulsion of the thumb and significant loss of the distal radial and carpal column, resulting in severe wrist instability. We employed a three-segment vascularized osteocutaneous fibula flap to reconstruct the thumb and wrist to restore bony construct, carpal support, and soft tissue coverage. Thumb motion could not be achieved, but this technique offered a sensate, functional post for opposition and the appearance of an anatomic hand. Because of this surgery, the patient was enabled to graduate from college and pursue full-time employment. The authors hope that this report will add to the fund of knowledge and surgeon armamentarium for similar devastating injuries demanding thumb and wrist reconstruction.
文摘目的建立一种标准化、可重复、简易的数字化评估方法,精确评估计算机辅助游离腓骨下颌骨重建术后效果。方法通过对20例因肿瘤致下颌骨缺损后行计算机辅助游离腓骨下颌骨重建手术病例的回顾性分析,在Mimics Research 21.0及3-matic Research 13.0软件辅助下对重建术前与术后冠状向、矢状向与轴向下颌角进行测量分析,评估计算机辅助游离腓骨下颌骨重建术后效果。结果在计算机辅助游离腓骨下颌骨重建的20例患者中,术前健侧和患侧冠状下颌角、轴向下颌角差异无统计学意义(P>0.05),矢状下颌角差异有统计学意义(P<0.05);术后健侧和患侧冠状、矢状、轴向下颌角差异均无统计学意义(P>0.05)。术前与术后健侧和患侧冠状、矢状、轴向下颌角差值的绝对值差异有统计学意义(P<0.01)。Ⅰ类缺损术前健侧和患侧矢状下颌角、术后健侧和患侧轴向下颌角差异有统计学意义(P<0.05),其余各类缺损术前与术后健侧和患侧三维下颌角差异均无统计学意义(P>0.05)。Ⅰ类缺损术前与术后健侧和患侧矢状、冠状下颌角差值的绝对值差异无统计学意义(P>0.05),其余各类缺损术前与术后健侧和患侧三维下颌角差值的绝对值差异均有统计学意义(P<0.05)。结论计算机辅助游离腓骨下颌骨重建对于肿瘤造成的三维方向的颌骨畸形均有显著的改善,能有效恢复下颌骨解剖结构的精确对称,应用本研究的评估方法能精确地评估下颌骨重建术后效果,为术前的设计提供指导。
