复拇指畸形矫治术后的继发性畸形

Secondary deformity after correction of thumb polydactyly

目的 探讨先天性复拇指畸形手术后的继发性畸形和处理方法。方法 对 12例先天性复拇指畸形经矫治术后出现拇指侧偏、内收、虎口狭窄、骨骺残留等继发性畸形的患者 ,进行拇指指间关节融合、掌骨截骨、骨骺切除、虎口成型、拇短展肌止点重建等手术 ;以纠正畸形、改善拇指的外形及功能。结果 术后随访 3至 6个月 ,除 1例较术前稍有改善外 ,11例拇指的外形明显改善 ,拇指对掌、对指功能基本恢复。结论 先天性复拇指畸形单纯手术切除后又出现继发性畸形 ,和过早 ( 2岁以前 )手术有关。患儿手指细小 ,组织结构辨认不清 ,可导致畸形矫治不彻底而出现继发性畸形。作者认为复拇指畸形的手术时机在 2～ 6岁为好 ,畸形复杂者在学龄前手术为佳。

Objective To investigate the secondary deformity after the correction of the congenital thumb polydactyly and its treatment outcome. Methods Twelve cases with congenital thumb polydactyly had secondary deformity after deformity correction, such as thumb angular deformity, thumb adduction, constriction of web space, or residue of epiphyses, etc. The thumb interphalangeal arthrodesis, amputation of metarcarpal, resection of epiphysis, web space plastic surgery, reconstruction of the insertion of the abductor pollicis brevis were carried out for correction of deformity and improvement of the thumb appearance and function. Results The postoperative follow-up was 3 to 6 months. Eleven cases had marked improvement in appearance, recovery near normal in thumb opposition and thumb-to-digit, except that slight improvement in 1 case. Conclusion The secondary deformity after surgical correction in the congenital thumb polydactyly is related with early surgical timing(patients before 2 years ages). The structure in the small finger is difficult to identify, so that secondary deformity occurs after the incomplete deformity correction. We consider the surgery will be generally performed when the child is about 2 years but no later than 6 years. For the patients with the complex deformity, the surgery should be performed before school age.