顶端移位术在镜影手畸形拇指重建中的应用

The application of on-top-plasty in thumb reconstruction of mirror hand deformity

目的探讨采用顶端移位术在镜影手畸形拇指重建中的临床疗效。方法回顾性分析2015年1月至2018年6月,西京医院收治的5例镜影手畸形患儿,男3例,女2例,年龄1岁8个月至5岁10个月。采用将桡侧外形及功能较好手指的顶端,移位至掌骨位置适中手指近端的手术方式重建拇指。术后对患儿进行随访,采用中华医学会手外科学分会拇指再造功能评分标准(0~15分)评价再造拇指功能,Kapandji评分(0~10分)评价拇指对掌功能,测量重建拇指的虎口外展角度、拇指长度、对捏功能。采用SPSS 19.0软件对各数据进行统计学分析,P<0.05表示差异有统计学意义。结果5例重建拇指均存活。术后随访1.5~5.0年,平均3.3年。末次随访重建拇指外形及功能满意。术前、后患手虎口外展角度分别为44.80°±4.02°及80.60°±8.02°,拇指长度分别为(9.02±1.56)cm及(5.86±0.86)cm,拇指对掌Kapandji评分分别为(3.20±0.84)分及(6.6±1.14)分,手术前、后对比差异均有统计学意义(P<0.05)。按照中华医学会手外科学分会拇指再造功能评分标准评分,优2指,良3指,优良率100%。结论采用顶端移位术重建镜影手畸形拇指,外形及功能均能取得良好的效果。

Objective To evaluate the clinical effect of the on-top-plasty technique in thumb reconstruction of mirror hand deformity.Methods From Jan 2015 to Jun 2018,five children,diagnosed as mirror hand deformity,were retrospectively analyzed in hand surgery department of Xijing Hospital,male 3 case,female 2 case,the age ranged from 1 year 8 mouths to 5 years 10 mouths.To reconstruct the thumb,the top of the radial digit,which had better appearance and function,was selected and transferred to the proximal part of digit that had good position of metacarpal.The thumb reconstruction function scoring standard in Hand Surgery of Chinese Medical Association(0-15)and Kapandji opposition score(0-10)were applied to evaluate the treatment effect.Using SPSS 19.0 statistical software for statistical analysis,the measurement data were expressed by the mean standard deviation,t test was used to analyze the abduction angle,thumb length,thumb-to-palm and kneading function before and after operation.P<0.05 showed significant difference.Results All of the five transferred thumbs survived postoperatively.The follow-up interval ranges from 1.5 years to 5.0 years(mean 3.3 years).The shape and function of the reconstructed thumbs were satisfactory at the last follow-up.The pre-operative and post-operative thumb web space were 44.80°±4.02°and 80.60°±8.02°respectively,the length of the thumbs were(9.02±1.56)cm and(5.86±0.86)cm respectively,Kapandji opposition score were 3.20±0.84 and 6.60±1.14.All of the pre-operative evaluation indicators above have statistical significance compared with post-operative ones(P<0.05).The results concluded 2 excellent and 3 good according to the thumb function scoring standards in Hand Surgery of Chinese Medical Association,which have a good above rate of 100%.Conclusions The application of on-top-plasty technique in thumb reconstruction of mirror hand deformity can achieve good results of the reconstructed thumb both in cosmetic appearance and functional recovery,which obtains satisfactory results from the children and parents.