Bilhaut-Cloquet手术治疗复拇指畸形效果分析

BILHAUT-CLOQUET SURGERY FOR THUMB DUPLICATION:EFFECT ANALYSIS

目的探讨Bilhaut-Cloquet手术治疗WasselⅠ型和Ⅱ型复拇指畸形的效果。方法回顾性分析采用Bilhaut-Cloquet手术治疗复拇指畸形病儿25例临床资料。结果术后25例均得到随访,随访时间2～4年,平均2.7年,切口及截骨处均愈合良好。外观存在拇指粗大病儿8例,拇指细小6例,指甲畸形8例,背侧明显皮肤瘢痕组织6例,掌侧明显皮肤瘢痕组织3例。术后指间关节主动屈曲平均55°,主动伸直受限平均25°;掌指关节主动屈曲平均75°,主动伸直受限平均10°。WasselⅡ型存在桡偏3例,平均10°;尺偏2例,平均7°。按TAM标准评定疗效,优1例,良16例,可8例。结论 Bilhaut-Cloquet手术能有效治疗复拇指畸形,但需严格掌握适应证。

Objective To investigate the efficacy of Bilhaut-Cloquet surgery for type Wassel Ⅰ and Wassel Ⅱ thumb duplication. Methods Clinical data of 25 cases of thumb duplication in children treated with Bilhaut-Cloquet surgery were reviewed retrospectively. Results All of the 25 patients were followed up after surgery for 2--4 years, with an average of 2.7 years. The incisions and osteotomy sites all healed well. In appearance： coarse thumb was noted in eight cases, small thumb in six, nail deformity in eight, dorsal skin scar in six and palm-side skin scar in three. On activities of the finger joints., interphalangeal joint （IPJ） active flexion was average 55 degrees, and average limited degree of active extension was 25 degrees. As for metacarpophalangeal joint （MPJ）, the average degree of active flexion was 75°, the average degree active straight limited was 10°. In Wassel Ⅱ , thumb radial deviation was found in three cases, with an average of 10°, and thumb ulnar deviation was noted in two cases with an average of seven degrees. According to ATM standard evaluation of curative effect, one case was classified as excellent, 16 as good and eight as fair. Conclusion Bilhaut-Cloquet surgery can effectively treat thumb duplication deformity, but the indications of surgery need to be strictly screened.