先天性拇指多指畸形手术治疗的临床研究

Assessment of outcome of congenital thumb duplication with corrective surgery

目的探讨先天性拇指多指畸形手术治疗的疗效及手术时机。方法回顾分析我院从2008年11月到2016年5月收治的31例(33侧)先天性拇指多指畸形的患者,其中男性23例,女性8例,年龄10月~4岁,平均1.8岁。左侧10例,右侧23例,双侧2例。按照Wassel分型,其中Ⅰ型1侧,Ⅱ型7侧,Ⅲ型1侧,Ⅳ型20侧,Ⅴ型1侧,Ⅶ型3侧,双侧拇指多指畸形中,一侧Ⅱ型,一侧Ⅳ型2例。有一例患者一侧Ⅶ型,对侧是单纯三节拇畸形。入院后行个性化手术治疗,针对不同的分型采用相应的方法切除异常的骨和软组织,进行拇指外展功能重建。结果所有的患者术后伤口一期愈合,平均术后3~7天出院,没有出现伤口血肿和感染等并发症。31例患者均获得随访,平均随访时间2年(6月~4年)。X线片复查,对于有截骨矫形的患者,平均术后6周骨性愈合。患者拇指外形比健侧略小,外展功能,对掌功能恢复良好。末次随访时,根据改良Tada评分标准进行评价,优26侧,良6侧,差1侧,优良率96.9%。结论先天性拇指多指畸形患者应根据具体的病理情况选择个性化的手术方式,在矫正外形的同时,重建拇指的功能,手术时机在1岁左右为宜,在患儿开始发展拇示指捏持功能前进行,有利于拇指功能恢复。

Objective To explore the clinical functions outcome and the operation opportunity of the surgical treatment ofcongenital thumb duplication. Methods From Nov 2008 to May 2016, thirty-one patients （33 sides） with congenital thumb duplication were treated with individual corrective surgery of 33 thumbs, 1 was rated as type 1, 7 as type II, 1 as type in, 20 as type IV, 1 as type V, and 3 as type W according to Wassel classication. There were 23 males and 8 females, with an average age of 1.8 years （ranged 10 months to 4 years）. The duplication was bilateral in 2 patients （one side as type II, the other side as type IV）, on the right side in 23 patients, and on the left side in 10 patients. One patient had a type VH thumb deformity and a triphalangeal thumb on the other hand. During the operation, the anatomical structure was dissected to observe the structure and alignment of the thumb. The abnormal bone and soft tissue were re-moved. In the meantime, collateral ligament and joint capsule was reconstructed,the endpoint of the abductor pollicis brevis was shifted. Results Postoperative wound smoothly healed in all patients and no incision complications occurred. All patients were followed up from 6 to 48 months （mean： 24 months）. The thumb configuration, the flexion and extension, the function of opposition and abduction were improved in 31 cases. The incision scar at the thumb was small without contraction deformity, small first web space, and secondary deviation deformity. On the X ray film review, the bone union signs were visible at 6 weeks after the osteotomy. We adopted Tien＇s modified Tada scoring system to evaluate the follow-up results, the excellent in 26 sides, the good in 6 sides, and poor in 1 side, good rate 96.9%. Conclusion Treatment of congenital with individual corrective surgery can get good results, restore the appearance and function. Based on the anatomical structure, the time of operation is about 1 years old. individualized treatment plan and select op-timal operation time is very important.