儿童Wassel IV-D型复拇畸形的解剖学研究

Anatomical study of Wassel type IV-D thumb duplication in children

目的 探讨儿童Wassel IV-D复拇畸形的病理解剖.方法 本组11例12手,男7例8手,女4例4手.其中4例为继发性畸形.术中对组织结构进行解剖,观察屈伸肌腱结构及走向、骨关节的解剖结构.结果 4例术后发生继发性畸形的病例,肌腱分叉后滑车缺如,屈拇长肌腱止点附着于拇指末节基底桡侧.Wassel IV-D型屈拇长肌腱鞘管在A2区发育为膜状,附着于两拇指近节指骨的相对侧,屈肌腱在近节指骨中远1/3处分叉,由一束变为两束,桡侧束止于桡侧指末节指骨基底的尺侧,尺侧束止于尺侧指末节指骨基底的桡侧.桡侧指末节向尺侧轻度旋转,尺侧指向桡侧轻度旋转.结论 Wassel IV-D型屈拇长肌腱鞘管在分叉以远发育为膜状,附着于两拇指近节指骨的相对侧,屈肌腱在近节指骨中远1/3处分叉,由一束变为两束,桡侧束止于桡侧指末节指骨基底的尺侧,尺侧束止于尺侧指末节指骨基底的桡侧.

Objective To investigate the anatomical features of the Wassel type IV-D thumb duplication in children.Methods There were 11 patients （7 males,8 hands; 4 females） in total.Four of them were secondary deformity.The anatomical structure and direction of the tendon and the action on the joint were observed during corrective surgery.Results Four patients had secondary deformity,A2 pulley was absent,tendon flexor hallucis longus clinged to the radial side of the small thumb.Flexor tendon sheaths of the Wassel IV-D developed into membrane in A2 area.They attached to two close section of the opposite side of the proximal phalanx of the thumb.The flexor tendon in the A2 area forked into two,with one ended on the of the base of the phalanx,and another ended on the radial side.There was mild ulnar rotation on the radial end of phalanx,and mild radial rotation on the ulnar end of the phalanx.Conclusions Flexor tendon sheaths of the Wassel IV-D developed into membrane in A2 area.They attached to two close section of the opposite sides of the thumb proximal phalanx,while the flexor tendon in A2 area forked into two at the 1/3 site,one ended in the of the base of the phanlanx,and another ended on the radial site.