先天性手足多指(趾)畸形的外科治疗(附19例病例)

Surgical Treatment for Congenital Polydactyly(19 cases report)

目的:探讨多指(趾)的手术治疗方法及注意事项,以提高对先天性多指(趾)的手术成功率。方法:本组男性8例,女性11例。年龄最小1.2岁,最大43岁,平均年龄11.63±10.45岁。左侧12例,右侧7例。其中多指6例,足部多趾13例(均为重复小趾畸形),有1例伴有手部并指畸形,有2例伴有足部并趾畸形。参考Wassel法分类,手部拇指畸形Ⅰ型(末节分叉型)2指,Ⅲ型2指(近节分叉型),小指畸形Ⅳ型(近节成对型)2指;足趾Ⅱ型(末节趾骨复趾型)2趾,Ⅲ型(近节趾骨分叉型)2趾,Ⅳ型(近节趾骨复趾型)5趾,Ⅴ型(跖骨分叉型)2趾,Ⅵ型(跖骨复趾型)2趾。所有患者术前均经临床查体和影像学检查评估,以确诊软组织多指或骨性多指(趾),并根据这些资料分型和制订出个体化的手术方案。临床查体包括记录多指(趾)畸形的类别和其活动范围。对伴有并指畸形者,需同时检查指间软组织的松弛程度,决定指蹼的皮瓣设计。结果:术后常规X线摄片均显示多指(趾)完全切除,正常指(趾)位置满意。经6个月～4年随访,外形和发育良好,功能达到正常运动和日常生活需要;除有1例并指畸形早期出现皮肤少许坏死,经局部伤口换药后治愈。没有关节僵硬及局部疼痛等并发症发生,对手术的满意度为94.74%(18/19)。结论:多指(趾)畸形的手术治疗不仅有助于手足部的功能重建,适应日常生活的需要,还有明显的美容效果。术前应详细了解多指(趾)局部解剖结构特点,认真设计手术方案。只有对皮肤、肌腱、韧带、关节囊、骨与关节等组织进行矫正与修复,才能获得良好效果。

Objective： To explore the surgical treatment and announcements for polydactyly, in order to improve the surgical achievement ratio of polydactyly. Methods： There were 8 males and 11 females in this group . Age ranged from 1.2 years to 43 years（ mean age of 11.63 - 10.45 years）. Polydactyly were oll left side in 12 patients, the right side in 7 patients. 6 patients had polydactyly of hand, 13 patients had foot polydactyly （all belong to digims lniuimus defomlities）.Among them, 1 cases with hand syndactyly, 2 cases with foot syudactyly. According to Wassel classification method, 4 patients belonged to deformity of hand thumb（ type I in 2 patients , type Ⅱ in 2 patients ）;2 patients belonged to type IV deformity of little finger;others belonged to deformity of＇toe（type Ⅱ iu 2 patients,type Ⅲ in 2 patients, type IV in 5 patients,type Ⅵ in 2 patients.）All patients were preoperatively diagnosed by clinical physical examiuatiou and radiological assessment to determine whether it belonged to polydactyly of soft tissue or bone.Theu individualized surgical program was worked out . Physical exanunation included records of classification and scope of activities of polydactyly .For the patients with syndactyly, checking extent of soft tissue relaxatiou and designing fingerweb flap were also perforned. Results： X-ray showed that polydactyly had been completely removed, the position of remained digit was satisfactory. After follow-up for 6 months to 4 years, appearance and development of remained digit was well, its function could satisfy normal exercise and daily needs; A little necrosis of skin happened in one patient with syndactylia, and wound healed after change of dressing. There was no other complication like stiffiless of joint, pain of remained digit in other patients with satisfactory rate of 94.74% （18/19）. Conclusion： Surgical treatment for polydactyly not only could conduced to reconstruction of hand or foot,butt also have cosmetic effect. Anatomical features of polydactyly should be learued before operation and carefully designed surgical procedure. Only could correction and rehabilitation for skin, tendou, ligament, joint capsule, bone and joints obtain good results.