Ueba术式治疗ManskeⅠ期至Ⅲ期分裂手畸形的疗效分析

Outcomes analysis of treating Manske type Ⅰ to Ⅲ cleft hand with Ueba procedure

目的评估Ueba术式治疗ManskeⅠ期至Ⅲ期分裂手畸形的主观和客观疗效。方法自2008年1月至2014年12月共收治ManskeⅠ期至Ⅲ期分裂手患儿11例（15手），男8例，女3例；年龄25～87个月，平均40个月。手术方法均采用Ueba术式，即在分裂畸形处设计三个皮瓣；将示指序列截骨向尺侧移位，同时适度旋后；重建示指和环指间的掌骨头间深横韧带。Ⅱ期和Ⅲ期病例在上述步骤的同时，行拇、示指并指分指，局部皮瓣转移开大虎口。术者和家长通过视觉模拟评分系统（visual analog scale，VAS）对术前和术后患肢的外观和功能进行主观评分。客观检查指标包括：手指活动度，掌骨分叉成角和指骨分又成角的测量。结果术者的VAS评分明显增加，由术前3．1分增至术后7．5分。术后家长非常满意6手，满意4手，基本满意4手，不满意1手。示指的活动范围术前271°，术后263°；环指活动范围术前267°，术后262°，术前与术后测量结果差异无统计学意义。掌、指骨分叉角度改善明显，掌骨术前分叉角度34°，术后13°；指骨术前分叉角度45°，术后140°结论Ueba术式是治疗分裂手畸形的有效方法，术后患儿手部的外观改善明显，手指的活动范围无显著影响。

Objective To evaluate the subjective and objective outcomes after Ueba reconstruction of Manske type Ⅰ to Ⅲ cleft hand. Methods Eleven patients with 15 cleft hands from Manske type Ⅰ to Ⅲ were treated from January 2008 to December 2014. There were 8 males and 3 females, with an average age of 40 months （range, 25 to 87 months）. Ueba procedure was applied for the reconstruction. Three skin flaps were made within the cleft. The index ray was transferred tdnarward and supinated. A transverse metacarpal ligament reconstruction was performed. Simultaneously, Manske type Ⅱ and Ⅲ patients were treated with a rotation flap from the cleft and full thickness skin graft from groin to reconstruct the first web space. Both the surgeon and the parents assessed the subjective outcomes using a visual analog scale （VAS） to compare preoperative and postoperative appearance. Objective outcomes evaluations included range of motion （ROM） of the digits, and measurement of divergence angles of the index finger and ring finger metacarpals and phalanges on X-rays. Results The surgeon＇s VAS score increased from 3.1 preoperatively to 7.5 postoperatively. The patients were very satisfied with 6 hands, satisfied with 4 hands, somewhat satisfied with 4 hands, and dissatisfied with 1 hand. ROM of index fingers were 271° preoperatively and 263° postoperatively. ROM of ring fingers were 267° preoperatively and 262° postoperatively. There was no statistically significant difference between the preoperative and postoperative ROM. The metacarpal divergence angle significantly improved from 34° to 13°, while the phalangeal divergence angle significantly improved from 45°to 14°. Conclusion Ueba procedure improves hand appearance in patients with cleft hand without