重复拇指畸形切除术后拇外展功能丧失的临床诊治

Clinical diagnosis and treatment of bunion abduction loss after resectionof double thumb malformation

目的:探究重复拇指畸形切除术后拇外展功能丧失的临床诊断和治疗方法。方法:对佛山市中医院骨二科2012年9月-2015年9月收治的13例重复拇指畸形切除术后拇外展功能丧失患者临床进行回顾性分析。男8例,女5例,年龄3~22岁,平均年龄(7±2.56)岁,左拇7例,右拇6例。通过患者术前体查及影像学资料,根据Wassel分型及功能重建供区情况,制定个性化的拇外展功能重建方案,包括掌长肌转位、环指指浅屈肌转位及软组织平衡。结果:术后石膏外固定6周,13例患者术口均一期愈合。全部病例均获得随访,随访时间12~38个月,平均23个月。根据改良Tada评分进行评估,优8例,良4例,中1例,差0例,术后拇指发育良好。结论:重复拇指畸形纠正不能单纯手术切除赘指,对于已造成拇外展功能丧失患者需根据供区情况选择个体化矫形方式。

Objective:To explore the clinical diagnosis and treatment of bunion abduction loss after resection of repetitive thumb malformation.Methods:A retrospective analysis was conducted on 13 patients with bunion abduction loss after resection of double thumb deformity admitted to the second department of orthopedics,Fuoshan hospital of traditional Chinese medicine from September 2012 to September 2015.There were 8 males and 5 females aged from 3 to 22 years old,with an average age of(7±2.56)years old.There were 7 cases of left thumb and 6 cases of right thumb.Based on preoperative physical examination and imaging data of patients,according to Wassel classi fication and functional reconstruction of donor area,a personalized reconstruction plan of abductor pollicis was developed,including palmar longus muscle transposition,ring finger flexor super ficial transposition and soft tissue balance.Results:After 6 weeks of external fixation with plaster,all the 13 patients had primary healing.All patients were followed up for 12 to 38 months,an average of 23 months.According to the modified Tada score,8 cases were excellent,4 were good,one was medium,and 0 were poor.Postoperative thumb development was good.Conclusions:The correction of double thumb deformity cannot be performed by simple surgical resection.For patients with bunion abduction loss,individualized orthopaedic methods should be selected according to the situation of the donor area.