伴第4、5趾并趾的小趾多趾畸形的外观与骨关节表现差异分析

Analysis of the difference between the appearance and the bony structure in the polysyndactyly of the fifth toe fused with the fourth toe

目的 探讨根据伴第4、5趾并趾的小趾多趾畸形的外观、X线片以及术中所见骨关节表现差异进行分析、分型,以确定拟切除的多趾以及足趾畸形的矫正方法的临床效果.方法 2009年1月至2014年1月共收治54例伴第4、5趾并趾的小趾多趾畸形的患儿,对其足趾外观、X线片表现以及术中所见骨关节情况进行比较分析及分型,并确定拟切除的多趾,同时分离并趾,矫正第6趾偏斜及短趾畸形.结果 根据骨关节分型,本组17侧足第5趾为肉赘型,48侧足第5趾为骨关节连接型,虽有骨关节与第6趾相连,但与近端骨关节对位对线差,故本组病例均确定第5趾为需切除的多趾.术后随访1个月至4年,保留的第6趾偏斜畸形完全矫正,短趾畸形得以改善.结论 根据伴第4、5趾并趾的小趾多趾畸形的外观与骨关节表现情况进行分析、分型,并由此制定拟切除的多趾（通常是第5趾）和不同的足趾畸形矫正方案,既可以恢复正常的骨关节,又能改善足趾外形.

Objective To investigate difference between the appearance and the bony structure in the polysyndactyly of the fifth toe fused with the fourth toe.Methods From Jan.2009 to Jan.2014,54 patients （65 feet） with polysyndactyly of the fifth toe fused with the fourth toe were treated.The appearance,X-ray and intraoperative finding were recorded and compared to classify the deformity.Then the extra toe was excised and syndactyly was separated.The malalignment and brachydactyly of the sixth toes were corrected simultaneously.Results According to the bone and joint type,the fifth toes were neoplastic toes without joints in 17 feet,or had poor bony and joint alignment with the sixth toes in 48 feet.So the fifth toes were excised in all the cases.The patients were followed up for 1 month to 4 years.The oblique deformity of sixth toes were corrected completely with improved length.Conclusions The polysyndactyly of the fifth toe fused with the fourth toe should be classified to design the excised toe（usually fifth toe） and correction procedure.The appearance and bony joint recovery are both important.