顶部转移术治疗Wassel Ⅵ型拇指多指畸形

The treatment of Wassel type Ⅵ thumb duplications with on-top-plasty

目的探讨顶部转移术治疗Wassel Ⅵ型拇指多指畸形的疗效及术中注意事项。方法自2012年4月至2018年6月采用顶端移位术治疗Wassel Ⅵ型拇指多指患儿8例。术后客观评价包括拇指是否偏斜,掌指(MP)关节、指间(IP)关节、第一腕掌(CMClst)关节被动活动度;放射线检查评价拇指力线,骨愈合时间,观察第一掌骨发育情况。主观评价由患儿家长完成功能和外观满意度问卷调查。结果术后随诊2.36个月,平均19.5个月,拇指无偏斜,MP、IP、CMC关节被动活动度较健侧无明显下降,术后X线显示7例患儿第一掌骨力线良好,1例畸形愈合,骨愈合时间5.7周,平均6.2周,患儿第一掌骨发育无迟缓。主观满意度调查功能优4例,良3例,可1例;外观优4例,良2例,可1例,差1例。结论顶部转移术是治疗Wassel Ⅵ型拇指多指畸形的一种有效方法,术前充分评估,术中根据虎口挛缩情况选择不同切口,明确辨认各解剖结构,保护血管蒂,是恢复拇指功能的基本保证。

Objective To investigate the clinical efficacy and intraoperative attention of on-topplasty technique for treatment of Wassel type Ⅵ thumb duplications. Methods From April 2012 to June 2018, 8 cases of Wassel type Ⅵ thumb duplications were treated by on-top-plasty. Postoperative objective evaluation included whether the thumb was deflected, passive range of motion of the metacarpophalangeal (MP) joint, interphalangeal (IP) joint and the first carpometacarpal (CMClst) joint. Radiographic examination was used to evaluate the force line of thumb, bone healing time and the development of the first metacarpal bone. Subjective evaluation was completed by the parents of the patients with functional and appearance satisfaction questionnaire. Results The follow-up period ranged from 2 to 36 months, with an average of 19.5 months. No deflection of thumbs occurred. The range of passive motion of MP, IP and CMC joints was not significantly decreased compared with the healthy side. Postoperative X-ray showed that the force line of the first metacarpal bone was good in 7 cases and malunion in I case. The bone healing time ranged from 5 to 7 weeks with an average of 6.2 weeks. There was no retardation in the development of the first metacarpal bone. The function of subjective satisfaction survey was excellent in 4 cases, good in 3 cases, fair in 1 case and the appearance was excellent in 4 cases, good in 2 cases, fair in 1 case, poor in 1 case. Conclusion On-top-plasty technique is an effective method to treat Wassel type Ⅵ thumb duplications. The full preoperative evaluation, different incisions according to the contracture of thumb web, clear identification of anatomical structures and protection of vascular pedicles are the basic guarantee for restoring thumb function.