皮肤软组织松解加游离植皮术治疗Ⅱ型先天性扣拇畸形

Treatment of type Ⅱ congenital dasped thumb with skin and soft tissue release and full thickness skin graft： a clinical analysis

目的探讨皮肤软组织松解加游离植皮术治疗Ⅱ型先天性扣拇畸形的疗效。方法自2014年1月至9月，我科收治10例Ⅱ型先天性扣拇畸形患者，共12只手，男6例，女4例；年龄2～7岁，平均3．5岁。右手7只，左手5只。术前测量拇指桡侧被动外展平均（24．830±4．218）°，掌侧被动外展平均（20．580±2．503）°，拇指被动背伸平均（-24．420±30．705）°，所有患手行拇指蹼皮肤软组织松解开大成形，第一掌指关节掌侧皮肤软组织松解，克氏针固定，全厚皮片游离植皮术，其中2只手行拇长屈肌延长术，术后保护性支具固定。术后2周拆线，4周拔除克氏针，同时拇指主被动背伸外展功能锻炼，夜间佩戴拇指背伸外展支具至12周。结果术后平均随访4个月，12只手扣拇畸形纠正，抓握功能明显改善，拇指桡侧被动外展平均4（4．830±4．218）°，掌侧被动外展平均（44．250±3．251）°，拇指被动背伸平均（-2．000±7．793）°，明显大于术前，差异有统计学意义（P〈0．05）。结论拇指蹼及第一掌指关节掌侧皮肤软组织松解加游离植皮术治疗Ⅱ型先天性扣拇畸形的拇指屈曲内收挛缩，此术式安全、简单，疗效可靠。

Objective To evaluate the results of skin and soft tissue release and full-thickness skin graft in the treatment of type Ⅱ congenital clasped thumb. Methods Ten patients with 12 affected hands were treated from January to September 2014 for type Ⅱ congenital clasped thumb. There were 6 males and 4 females, with an average age of 3.5 years （range, 2 to 7 years）. Seven cases were on the left side and 5 on the right side. Preoperative passive motion of the thumb was （24. 830 ± 4.218） ° for radial abduction, （20.580 ± 2.503）° for palmar abduction and （ - 24.420 ± 30.705）° for dorsiflexion. Surgical management consisted of skin and soft tissue release of the first wed space, release of the volar contracture of the first metacarpophalangeal joint, K-wire fixation of the widened first web space or straightened MP joint （if necessary）, and full-thlckness skin graft. Two hands had the flexor pellicis longus （FPL） tendon lengthened. All the hands were immobilized in a splint. The K-wires were removed 4 weeks after the surgery. Functional exercise included active and passive thumb abduction and extension. The splint was continued only during the night until 12 weeks. Results All the patients were follow-up for a mean of 4 months. The clasped thumb deformity was corrected in all cases. Grip and pinch function was significantly improved. Postoperative passive motion of the thumb was （44. 830 ± 4.218）° for radial abduction, （44. 25±0 3. 251）° for palmar abduction and （- 2. 000 ±7. 793）° for dorsal extension, all significantly better than preoperative values （ P 〈 0.05）. Conclusion Release of the skin and soft tissue at the first web space and the volar aspect of the metacarpephalangeal joint followed by full-thickness skin graft is an easv, safe and reliable method for treating typeⅡ conzenital clashed thumb.