婴幼儿复拇畸形的Wassel分型及术式选择

Selection of the procedure for children with multihallucism according to Wassel type

目的探讨0～3岁儿童复拇畸形的临床分型及术式选择。方法对136例164指通过Wassel分型,选择切除副指,保留重建拇指屈伸肌腱,修整关节囊,恢复正常解剖结构,改善拇指外观及功能。结果所有患儿通过Wassel分型采用不同术式,拇指外观及功能均获得较满意的改善,平均手术时间45min。术后随访5个月～3年,并发症主要为:①掌指关节成角畸形(6例);②指间关节成角畸形(2例);③伸指功能及对掌功能差(2例);④关节僵硬(2例)。结论通过Wassel分型可指导手术方式的选择。较早期手术治疗可促进拇指发育及心理发育,结合支具及术后功能锻炼可获得更满意的疗效。

Objective to explore the effectivness of selection of procedure according to Wassel type of multihallucism. Methods 136 children with multihallucism were recruited from January 2000 and June 2009. 86 of the patients were males, and 50 were females, aged from lmonth to 3years. 164 thumbs presented multihallucism. Of the 136 patients, 64 presented left multihallucism, and 44 presented right, and 28 were bilateral. Results All patients successfully underwent selective operations according to Wessel type. The mean operation time was 45min （range 30-60min）. All patients were followed up 5m to 3years after operation. Angulation of metacarpophalangeal joints occurred in 6 patients. Angulation of articulationes interphalangeae occurred in 2 patients. Anchylosis was observed in 2 pantients. Joint stiffness was observed in 2 patients.Conclnsions The treatment in which patients with multihallucism underwent various orthomorphia according to Wessel type was feasible. And it may benefit the development of patients＇ thumb and psychology.