儿童Wassel Ⅳ-4型复拇畸形手术疗效分析

The Results of Surgical treatment in the Wassel type Ⅳ-4 thumb duplication

目的Wassel Ⅳ-4型复拇畸形．畸形复杂，治疗困难。本文介绍用改良的Bilhaut软组织合并矫形术治疗该型复拇畸形。方法2005年8月至2011年1月治疗21例WasselⅣ-4型复拇畸形，男13例（61．9％），女8例（38．1％），平均年龄1．2岁。手术采用改良的Bilhaut软组织合并术，桡侧拇指切除，尺侧拇指重建。包括肌腱转移：韧带重建、关节囊修补，皮瓣成形，软组织合并。结果19例术后平均随访25个月，对治疗结果用改良的Tada评分评估，优10拇（52．6％）。良7拇（36．8％），中2拇（10．5％）。结论改良的Bilhaut软组织合并术治疗复杂型Wassd Ⅳ-4型复拇畸形，重建拇指功能良好，外观优良。

Objective Wassel type Ⅳ-4 thumb duplication is difficuh to treat because of the se- vere deformity, This report is on the modified Bilhaut procedure soft tissue merged surgery for this type of deformity. Methods From August 2005 to January 2011,21 cases with Wassel type Ⅳ -4 thumb duplication,of which there were 13 males （61.9%） and 8 females （38. 1% ）, with an average age of 1.2 years underwent modified Bilhaut procedure （soft tissue merged surgery,excising the radial thumb and reconstruct the ulnar thumb. Including tendon transfers,ligamenl reconstruction,joint cap-sule repair, forming flaps, soft tissue merge）. Results 19 cases were followed up for an average of 25 months. A modified Tada scoring system was used to evaluate the resuhs of the treatment. These were excellent in 10 cases （52. 6%）, good in 7cases （36. 8%）, fair in 2 eases （10. 5%）. Conclusions Our technique can provide a satisfactory thumb appearance, and functionalily of thumb with Wassel type Ⅳ-4 thumb duplication.