一期双叶皮瓣联合环形外支架治疗儿童桡侧列发育不良

Treatment of congenital radial longitudinal defciency in children with one-stage bilobed flap combined with centralization by circular external fixation

目的探讨一期采用背侧双叶皮瓣转移平衡软组织缺损,结合环形外固定支架治疗儿童桡侧列发育不良的临床效果。方法回顾性分析无锡市第九人民医院2006年1月至2018年12月收治的14例桡侧列发育不良患儿资料,男性8例,女性6例,年龄3~17岁,平均9.7岁。左侧3例,右侧10例,双侧1例;Bayne分型Ⅱ型1例,Ⅲ型7例,Ⅳ型6例,2例伴有脊柱侧弯,术前腕关节桡偏角平均67.3°(30°~90°)。一期采用双叶皮瓣彻底松解软组织重建动力平衡,腕关节中置后利用环形外支架固定,4例同时行尺桡骨截骨后前臂延长(3例尺骨、1例桡骨截骨)。随访指标:短期内观察皮瓣成活情况,长期随访腕关节桡偏角、腕关节活动度。结果14例患儿术后1例患儿腕背皮瓣远端部分坏死,12 d后切除坏死部分直接缝合,其余均全部成活。随访2~8年(平均3.6年),腕关节桡偏平均9.3°(2°~17°),腕关节活动屈曲平均46.7°(25°~70°),背伸平均14.7°(5°~20°)。1例尺骨延长出现截骨端不愈合,于术后9个月行植骨内固定后达到骨愈合。所有患者前臂桡偏外观明显改善,功能恢复较好。结论一期双叶皮瓣联合环形外支架固定治疗儿童桡侧列发育不良可减少手术次数,获得满意的外观和较好的功能恢复,是一种有效的临床治疗方法。

Objective To introduce the clinical experience and treatment effect of congenital radial longitudinal deficiency in children with one-stage bilobed flap combined with centralization by circular external fixation.Methods Analysis and statistics from 14 children with radial longitudinal deficiency were summarized in our hospital from January 2006 to December 2018,8 males and 6 females;aged 3 to 17 years,average 9.7 years.3 patients on the left side,10 patients on the right side,1 case bilateral.1 case was typeⅡ,7 cases were typeⅢ,6 cases were typeⅣ.2 cases were with scoliosis.The radial angulation of 30°-90°(average 67.3°)before operation.In the first phase,bilobed flaps were used to completely release soft tissue and restore dynamic balance.After the centralization,it was fixed with a circular external fixation.Three cases underwent ulnar osteotomy and forearm extension at the same time.Follow-up indicators:Observe the flap survival in the short term,and follow up on the radial deviation of the wrist and the degree of wrist mobility for a long time.Results In one patient,the distal part of the dorsal wrist flap was necrotic,the necrotic part was removed and directly sutured 12 days later,and the rest all survived.During a follow-up period of 2 to 8 years(average 3.6 years),the average radial angulation was 9.3°(2°to 17°),the average flexion of the wrist was 46.7°(25°to 70°),and the average extension was 14.7°(5°to 20°).One case which forearm extension had a fractured nonunion and bone graft with internal fixation was performed in 9th after surgery,and ulna healed in 3 months after bone grafting.The forearm radial deflection was significantly improved in all patients,and functional recovery was satisfactory.Conclusions Treatment of radial longitudinal deficiency in children in one-stage bilobed flap combined with centralization by circular external fixation is an effective clinical treatment method.It can reduce the number of operations,obtain satisfactory appearance and receive good functional recovery.