双翼皮瓣指蹼成形在先天性并指畸形中的应用

The Repair of Double-wing Flap Webbed Plasty for Congenital Finger Deformity of Syndactylism

目的评价双翼皮瓣指蹼成形在修复先天性并指畸形中的应用效果。方法回顾性分析我院2015年4月～2017年4月行双翼皮瓣指蹼成形修复先天性并指畸形患儿49例(观察组)临床资料,以2013年1月～2015年3月行传统的掌背侧三角形皮瓣成形修复的46例先天性并指畸形患儿作为对照组。术后1、6、12个月门诊随访,观察患儿指蹼深度、宽度、坡度情况及是否有指蹼爬行,比较两组术后12个月挛缩引起继发畸形以及再次手术发生率。结果两组术后1个月指蹼深度、宽度、坡度满意率均为100%,指蹼爬升率均为0.00%,组间差异均无统计学意义(P>0.05)。术后6个月,观察组指蹼深度、宽度、坡度满意率均为100%,对照组分别为91.30%、93.48%和91.30%;观察组指蹼爬升率为0%,对照组为8.7%,组间比较差异均有统计学意义(P<0.05)。术后12个月,观察组指蹼深度、宽度、坡度满意率为97.96%、 100.00%和97.96%,对照组为89.13%、 91.30%和86.96%,观察组指蹼爬升率为0%,对照组为13.04%,组间比较差异均有统计学意义(P<0.05)。观察组术后12个月挛缩畸形和再次手术发生率均为0%,对照组分别为13.04%和10.87%,组间比较差异有统计学意义(χ~2=6.017,P=0.002;χ~2=5.472,P=0.013)。结论先天性并指畸形患儿采用双翼皮瓣指蹼成形可提高术后指蹼深度、宽度、坡度满意率,有效避免挛缩畸形和再次手术发生率。

Objective To evaluate the application effect of double-wing flap fingertip web shaping in the repair of congenital finger deformity of syndactylism. Methods A total of 49 children with congenital syndactylism repaired by double-wing flaps webbed in our hospital from April 2015 to April 2017 were researched as the observation group. 46 children of congenital syndactylism repaired by traditional dorsal palmar triangular flaps from January 2013 to March 2015 were taken as the control group. The depth, width, gradient and ascend of the finger web were followed up at 1, 6 and 12 months after the operation. And the re-deformity and re-operation was compared between the two groups. Results The satisfactory rate of finger web depth, width and gradient was 100% and the finger web ascending rate was 0% in both groups one month after operation, and there was no significant difference between the two groups(P>0.05). At six months after operation, the satisfactory rate of the finger web depth, width, gradient and the finger web ascending was 100%, 100%, 100% and 0% in the observation group, and those were better than 91.30%, 93.48%, 91.30% and 8.7% in the control group respectively, and all the differences were statistical significance(P<0.05). At twelve months after operation, the satisfactory rates of finger web depth, width, gradient and the finger web ascending were 97.96%, 100.00%, 97.96% and 0% in the observation group, and 89.13%, 91.30%, 86.96% and 13.04% in the control group,and there was statistical difference between the two groups( P< 0.05). The incidence of contracture deformity and reoperation was 0% in the observation group,and 13.04% and 10.87% in the control group respectively,and there was statistical difference between the two groups( P<0.05). Conclusion The surgical intervention of double-wing flap finger webbing plasty can improve the satisfaction rate of the depth,width and gradient of the finger webbing,and avoid the occurrence of contracture deformity and reoperation effectively for the children with congenital deformity of syndactylism.