先天性皮肤桥并指畸形临床分型及治疗策略

Clinical dassification and treatment strategy of congenital skin bridge syndactyly

目的总结和归纳先天性皮肤“桥”并指畸形的临床特点，建立临床形态学分型并确立相关的治疗策略。方法回顾性分析2002年2月至2011年8月治疗的先天性环状缩窄带畸形患者，其中合并皮肤“桥”并指畸形16例，依据指蹼的完整程度将其分为I型和Ⅱ型，每一型又根据皮肤“桥”与缩窄带的位置关系分为ⅠA、ⅠB、ⅠC和ⅡA、ⅡB、ⅡC各3个亚型。对相关类型的手术治疗原则进行总结，提出相应的治疗策略。结果16例随访时间为3～18个月，平均8．6个月。分离手指及缩窄带“Z”形松解三角形皮瓣全部存活，缩窄带远端手指水肿及血液循环不良的状况完全缓解或部分缓解。患者家长对手术效果的主观评价情况：手功能恢复非常满意25．0％，满意50．0％，不满意25．0％；手外形恢复非常满意12．5％，满意18．8％，不满意68．7％。结论目前分型反映了先天性皮肤桥并指畸形的形态学特点，依据本分型进行手术治疗可获得一定的临床效果，功能改善的结果优于外形。

Objective To review and summarize the clinical characteristics of congenital skin bridge syndactyly, and offer a clinical classification system and surgical treatment strategy. Methods A retrograde review of the congenital constriction band syndrome cases treated between February 2（D2 and August 2011 was conducted. A total of 16 eases with skin bridge syndactyly were identified. Based on the morphologic characteristics of inter-dlgital web space in fingers with skin bridge syndactyly, they were classified into type Ⅰ and type Ⅱ as web spaces were intact or not. TypeⅠ and type Ⅱ were sub-classified into type ⅠA, type ⅠB, type ⅠC and type ⅡA , ⅡB , ⅡC, respectively, based on the relative position between the ring band and skin bridge. Treatment methods of different types of the skin bridge syndactyly were analyzed, and a treatment strategy was suggested. Results The mean follow-up time was 8.6 months （range, 3 to 18 months）. All of the finger separations and Z-plasty procedures were successful. 75% of the parents were satisfactory with hand function, and 31.3% with hand appearance postoperatively. Conclusion The new classification system covers clinical and morphologic characteristics, and offers a basis for options of surgical treatment with congenital skin bridge syndactyly. Functional improvement was much better than aesthetic improvement.