儿童先天性拇指多指畸形手术时机选择的探讨

Operative opportunity of the polydactyly in children.

目的探讨儿童先天性拇指多指畸形的手术时机。方法对2008年8月至2011年12月经我们手术治疗的102例119指先天性多指畸形患儿进行回顾性分析，其中男性67例（65．7％），女性35例（34．3％）；年龄最小2个月，最大13岁，平均年龄（1．62±2．36）岁；左侧23例，右侧62例，双侧17例；5例伴有并指畸形。所有患儿术前均进行详细专科体查和影像学评估，根据患儿年龄、Wassel分型及畸形程度制订个体化手术方案，包括单纯多指切除术，各种皮瓣成形、肌腱移位（移植）、韧带重建、关节囊修复等矫形手术，部分大龄患儿酌情行截骨矫形术。结果81例术后随访3—27个月，平均随访11．6个月，根据改良Tada评分进行评估，优62指，良17指，中12指，差3指；2指术后2年出现继发性成角畸形，1指术后3年掌指关节桡侧残留骨骺，再次手术后外形及功能恢复正常。结论先天性拇指多指畸形的手术时机应根据拇指骨化中心出现时间而定，对于畸形严重、结构变异较大的复杂多指，应在严格把握手术时机的前提下，做好术前评估，制定个体化治疗方案，术中精细操作，术后长期定期随访。

Objetive To investigate the operative opportunity of the polydactyly in children. Methods A clinical study was performed on 119 fingers of the 102 patients （including 67 males ,35 females; mean age 1.62 ± 2.36 years; range 2 months to 13 years ; left hands was involved in 23 cases, the right one in 62 cases, and both hands in 17 cases ;5 case with syndactyly） of polydactyly were surgical treated from August 2008 to December 2011. All patients underwent detailed physical examination and radiological assessment, surgical methods should be selected according to the age, Wassel classification and deformity of the patient, treatment included resection of the most hypoplastic thumb ,followed by a variety of skin flap plasty, tendon shift （trans- plantation ） , reinsertion of the collateral ligament and the articular capsule, part of the older children underwent osteotomy discretion as appropriate. Results A total of 94 fingers of the 81 patients （79.4%） were followed up for an average 11.6 months （range,3 -27） , based on the upgrade Tada scoring system ,the results were ex- cellent in 62 ,good in 17 ,fair in 12 and poor in 3. Two thumbs appear secondary angular deformities after post- operative two years, and one thumb residual epiphysis of the radial side of metacarpophalangeal joint after three years, the appearance and function had been nearly normal after second operation. Conclusion The optimal surgical timing of polydaetyly should be based on the ossification center of thumb appears, The complex poly- daetyly that severe malformations and structural variation should strictly control the optimal surgical timing, pre- operative assessment of the conditions and formulate the individualized treatment programs for children, good performance during surgery and long-term regular follow-up after operation.