先天性钩状拇指的手术治疗

Surgical treatment of congenital clasped thumb

目的 探讨先天性钩状拇指不同类型的手术治疗方法.方法 回顾分析山东大学齐鲁儿童医院小儿外科手术治疗的17例先天性钩状拇指的临床资料.17例均为双侧,共34手,年龄3～9岁（平均7岁9月）;参照Weckesser分型.本组同一患儿双手分型相同,其中Ⅰ型9例（52.9%）,Ⅱ型5例（29.4%）,Ⅲ型3例（17.6%）;Ⅰ型采用示指固有伸肌转移或桡侧腕长伸肌和掌长肌腱移植重建拇指伸肌功能;Ⅱ、Ⅲ型通过松解指蹼挛缩、掌指关节关节囊、背侧骨问筋膜及拇收肌横头第三掌骨止点.并采用示指同有伸肌或桡侧腕长伸肌、掌长肌腱转移重建伸肌功能等方法治疗.结果 随访7个月至15年,17例中11例（64.7%）优,3例（17.6%）良,2例（11.8%）中,1例（5.9%）差.结论 针对先天性钩状拇指的不同类型采用相应不同的手术方法治疗,治疗效果显著.

Objective To present the surgical management of congenital clasped thumb.Methods The clinical data of 17 patients with congenital clasped thumb（CCT）were analyzed retrospectively.Thirty four affected hands of 17 patients with an average of 7 years and 9 months were recruited in this study.According to the Weckesser＇s classification,of the 17 cases,9 were graded as type Ⅰ,5 were type Ⅱ.and three were type Ⅲ.The 9 patients with type Ⅰ CCT underwent corrective surgery to transfer the extensor indicis proprius or the extensor carpi radialis longus,and transplant the palmaris longus to reconstruct the function of the thumb extensor digitorum.Of the other 8 patients with type Ⅱ and Ⅲ CCT,the affected hands were treated by releasing the contracture of finger web,the articular capsule of metacarpophalangeal joint,posterior interosseous fascia and the metacarpal bone insertion of caput transversum musculi adductoris hallucis：besides these,the same surgical procedure used on type Ⅰ patients was also performed to correct the deformities.Resalts All patients have been followed up for 7 months to 15 years.Among them,the healing and function of the fingers were excellent in 11 patients （64.7%）.good in 3（64.7%）,moderate in 2（64.7%）middle,and poor in 1（5.9%）.Conclusions The surgical management for congenital clasped thumb should be planned individually to achieve better outcomes.