带血管神经束的多指移位修复拇指外形的临床应用

Clinical application of transposition of polydactyly with neurovascular bundles in repairing of thumb form

目的探讨在拇指先天性多指切除矫形中将废弃赘生多指携带的血管神经束移位修复畸形拇指外形的临床应用和效果。方法2005年1月至2011年12月间，对6例拇指Ⅵ型多指畸形的治疗中，切除纤细和畸形的主干拇指末端部分，将生长在虎口处外形较好的赘生指截除掌骨后携带血管神经束经虎口、拇指尺侧方移位到主干拇指的末节进行固定，矫正拇指末节的外形。赘生指移位后同时进行虎口成型。结果转移的6例拇指全部成活，4周拔除克氏针，骨断端在4～6周愈合，术后随访3个月～1年，移植拇指外形美观，拇指指腹具有原有位置的感觉，拇指抓握、对指功能良好。结论应用显微外科技术将本应废弃的多指携带血管神经束进行移位修复主干拇指畸形，该手术方法简单易行，术后效果可靠满意，可临床推广和应用。

Objective To discuss the clinical application and therapeutic effect of repairing deformed thumb in the way of transposition of abandoned polydactyly with neurovascular bundles. Methods From January 2005 to December 2011, six cases of type IV deformities of thumb duplications were treated with excision of thin and defomled thumb phalangette of trunk, the redundant hyperdactylia, which was well-formed and involved in the first web space, was then transposed with neurovascular bundles to the thumb phalangette of trunk by the first web space and the side of thumb for fixation followed by repairation of form of thumb phalangette. The surplus metacarpal bone and phalanx of duplications were removed and the first web space was reconstructed. Results All 6 cases of heterotopie thumb phalangette transplanted to the deformed thumb phalangette were completely survived. Kirsehner wires were removed 4 weeks after operation. Fracture healing occured after 4 to 6 weeks after operation. Postoperative follow-up period ranged from 3 months to 1 year. Transplanted thumbs possessed well-formed appearance with previous sensation on the finger pulp as well as excellent function of grabbing and opposing. Conclusion To repair deformity of trunk thumb in the way of microsurgery by means of transposition of duplicated thumb with neurovaseular bundle which should be abandoned, is a simple operation with satisfactory and reliable postoperative effect. It shall he spred and applied.