先天性风吹手畸形的治疗

Treatment of the windblown hand deformity

目的探讨先天性风吹手畸形的治疗方法。方法对27例先天性风吹手畸形的患者采用分次手术的方法,一期改善拇指功能,作拇收肌切断、第一指蹼开大、拇指外展功能重建术;二期作中、小指指浅屈肌腱移位,纠正手指尺偏畸形;三期手术解决手掌、指屈曲、掌侧皮肤缺损。每次手术间隔3～6个月,期间配合系统的康复治疗。结果术后随访时间为6～72个月,5例失访。22例中有17例拇指外展、对掌、对指功能恢复,效果满意;12例手指尺偏畸形得到矫正,6例部分矫正,4例复发,其中7例再次行紧缩尺侧关节囊、调整肌张力手术,术后应用外展支具,系统康复训练后5例畸形矫正,2例部分矫正。术后8例再发手掌、指皮肤挛缩,再次行植皮术。3例发生不全并指,经指蹼成形后纠正。结论对复杂先天性风吹手畸形的治疗应分次手术为佳,每次解决一个主要问题,配合系统的康复治疗才能获得较满意的效果。

Objective To discuss the treatment of the windblown hand deformity. Methods Twenty- seven patients of windblown hand deformities were treated with staged operations. In the first stage division of the adductor pollicis muscle, first web widening and thumb opponenplasty were carried out to improve the thumb function. Transfer of flexor digitorum superficialis from the middle and little fingers was done in the second stage to correct ulnar deviation of the fingers. Third stage operations were directed to correcting flexion deformity of the palm and digits and resurfacing consequent skin defect. The interval between each operation was 3 - 6 months, during which rehabilitation therapy should be performed. Results Postoperatively the patients were followed-up for6 to 72 months. Five patients were lost for follow-up. Of the 22 patients with long-term follow-up, 17 had recovered abduction and opposition function of the thumb. Ulnar deviation of the digits was completely corrected in 12 patients and partially corrected in 6 patients. Recurrence of ulnar deviation was seen in 4 patients. Secondary surgery to release ulnar side joint capsule and tighten transferred tendon was done in 7 patients. Postoperatively abduction splint was applied with extensive rehabilitation. The deformity was corrected in 5 patients and partially corrected in 2. Skin contracture at the palm and volar side of the fingers was seen in 8 patients that required excision and skin graft. Incomplete syndactyly was noted in 3 cases which was corrected by web-plasty. Conclusion Windblown hand deformity is better treated in a staged fashion given its complexity. Focusing on one major problem at each stage and combining vigorous rehabilitation regimen is key to achieving satisfactory results.