自制儿童并指间皮肤牵张器的临床应用

The clinical application of a new external separation device for management of hand syndactaly in chil- dren

目的研制一种用于儿童皮肤性并指畸形的外固定装置——“儿童并指间皮肤牵张器”，并初步评价其临床疗效。方法自2011年3月开始至今，采用自行设计、研制的“儿童并指间皮肤牵张器”治疗儿童并指畸形共6例，均为第三、四指并指畸形，并指类型均为单纯皮肤性并指，右侧4例，左侧2例。安装并指间皮肤牵张器后，逐渐牵开并指间皮肤和软组织，达到预定设计要求后，二期行并指间皮肤牵张器拆除、并指分离术。从临床外观和功能评价其疗效。结果本组6例均获得随访，平均随访时间9个月（4～15个月）。6例均顺利采用并指间皮肤牵张器行并指间皮肤软组织牵张，二期行并指分离术时均不需要行游离植皮，指蹼重建满意，几无瘢痕，近期的临床外观满意。2例术前存在近侧指间关节僵硬、术后无改善；2例出现牵张过程中的甲床移位、并指分离时行甲床成形术；2例出现腕部固定针之针道感染，经对症处理后症状消失。结论“儿童并指问皮肤牵张器”应用于儿童的并指分离，其外固定装置设计合理、安装简单、并指间皮肤软组织牵张可靠、无需植皮，并指分离后外观功能满意，值得临床推广使用。

Objective To describe the development a new external fixation device for syndactyly,and to evaluate its clinical efficacy. Methods Since March 2011, a new external fixation device designed and developed by us, was used in 6 cases of syndactyly in children. All involved the third web,and were pure soft tissue syndactyly （4 cases on the right side, 2 on the left side）. After the new device was fixed on the third-fouth finger of the involved hand, gradual stretching of the web skin and soft tissue was done. After the ideal width of the stretched web skin was achieved, the device was removed, and syndactyly surgery was performed simultaneously. The efficacy of the device was evaluated according to the clinical appearance and function of the syndactyly fingers. Results During an average follow-up time of 9 months （4-15 months）,6 cases were successfully stretched using the new device and none needed skin graft during syndactyly surgery. All finger webs were rebuilt satisfactorily, with almost no scarring and excellent function. Conclusions The new external fixation device for syndactyly in children has many advantages：reasonable design, easy to use, reliable to stretch the web skin and soft tissue,reduce the need for skin graft, satisfactory cosmesis after surgery.