[Clinical observation of traumatically-damaged joint after its repair with transplantation of allogenic joint].
OBJECTIVE
To evaluate the long-term function of the traumatically-damaged joint after its repair with transplantation of a fresh or a frozen allogenic joint.


METHODS
From March 1977 to September 1993, 13 patients (9 males, 4 females; age, 17-55 years) with traumatically-damaged joints underwent transplantation of the fresh or the frozen allogenic joints. Five patients had 5 damaged metacarpophalangeal joints, 6 patients had 9 damaged interphalangeal joints, and 2 patients had 2 damaged elbow joints. So, the traumatic damage involved 13 patients and 16 joints. All the metacarpophalangeal joints and the interphalangeal joints were injured by machines and the 2 elbow joints were injured by road accidents. The patients were randomly divided into 2 groups: Group A (n=7) and Group B (n= 6). The 7 patients with 8 joints in Group A underwent transplantation of fresh allogenic joints; the 6 patients with 8 joints in Group B underwent transplantation of frozen allogenic joints. The allogenic joint transplants were performed in the period from immediately after the injuries to 6 months after the injuries. The motion ranges of the transplanted joints and the X-ray films were examined after operation, and the immunological examination was performed at 8 weeks after operation.


RESULTS
The time for synostosis was 5-8 months in Group A, but 4-6 months in Group B. In Group A, at 2 years after operation the metacarpophalangeal flexion was 30-40 degrees and the interphalangeal flexion was 20-30 degrees; however, at 6 or 7 years after operation the interphalangeal flexion was only 10-20 degrees. The patients undergoing the transplantation with fresh elbow joints had the elbow flexion of 60 degrees and the elbow extension of 0 degrees, and had the forearm pronation of 30 degrees and the forearm supination of 30 degrees. But in Group B, at 2 years after operation the metacarpophalangeal flexion was 60-70 degrees and the interphalangeal flexion was 40-50 degrees; at 6 or 7 years after operation the interphalangeal flexion was still 40-50 degrees. However, the patients undergoing the transplantation with frozen elbow joints had the elbow flexion of 90 degrees and the elbow extension of 0 degrees, and had the forearm pronation of 45 degrees and a forearm supination of 45 degrees. The joint motion ranges, the X-ray findings, and the immunological results in the patients undergoing the transplantation of the frozen allogenic joints were significantly better than those in the patients undergoing the transplantation of fresh allogenic joints. There was a significant difference in the immunological examination between Group A and Group B (IL-2, 21.64 +/- 3.99; CD4/CD8, 3.88 +/- 0.82 vs. IL-2, 16.63 +/- 3.11; CD4/CD8, 2.53 +/- 0.23, P<0. 01). Conclusion Repairing the traumatically-damaged joints with frozen allogenic joints is a better method of regaining the contour, movement, and complex motion of the hands.
Liu
Minghui
M
Department of Traumatic Surgery, First Affiliated Hospital of Harbin Medical University, Harbin Heilongjiang, China. harbinminghui@sina.com
Jia
Jifeng
J
Hou
Zhanjiang
Z
D000293:Adolescent; D000328:Adult; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D005383:Finger Injuries / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D007596:Joints / Q000637:transplantation*; D008297:Male; D008662:Metacarpophalangeal Joint / Q000293:injuries* / Q000601:surgery; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult; D000092464:Elbow Injuries