改良Snow-Fink肌腱移位术重建拇指对掌功能的疗效分析

Modified Snow-Fink opposition transfer technique for reconstruction of hypoplastic thumb opposition

目的 探究改良Snow-Fink肌腱移位术对重建先天性拇指发育不良患儿拇指对掌功能的效果。方法 回顾性分析我科从2014年至2021年收治的25例拇指发育不良患儿(Ⅱ型7例,ⅢA型8例,ⅢB型7例,Ⅳ型3例)的临床资料,其中Ⅱ型及4例ⅢA型患儿行改良Snow-Fink肌腱移位术,另4例ⅢA型患儿行一期虎口开大术及二期改良Snow-Fink肌腱移位术,ⅢB型及Ⅳ型患儿行一期虎口开大术+掌骨重建术,二期行改良Snow-Fink肌腱移位术。术后对患儿进行随访。从拇指外展功能、拇指对指功能、拇指对捏功能、拇指综合功能4个方面进行评价。结果 本组25例平均19.9个月,拇指桡侧外展角度平均61.0°,掌侧外展角度平均68.8°,Kapandji评分平均7.4分(满分10分),拇指对捏功能评分平均1.84分(满分2分),Goldfarb评分平均3.12分(满分4分)。其中1例术后出现环指指屈肌腱粘连。结论 改良Snow-Fink肌腱移位术可用于重建Ⅱ型及一期或多期拇指重建术后的Ⅲ、Ⅳ型拇指发育不良患者的对掌功能,其操作简便,损伤小,术后可恢复良好的拇指对掌功能,是重建拇指发育不良对掌功能的手术选择之一。

Objective To investigate effects of modified Snow-Fink opposition transfer technique on congenital thumb hypoplasia. Methods A retrospective study was conducted on 25 patients diagnosed as congenital thumb hypoplasia from 2014 to 2021 in Beijing Jishuitan Hospital( 7 patients with Blauth type Ⅱ thumbs, 8 patients with Blauth type ⅢA thumbs, 7 patients with Blauth type ⅢB thumbs and 3 with Blauth type Ⅳ thumbs). All of Ⅱ thumbs and 4 of ⅢA thumbs met modified Snow-Fink opposition transfer criteria;the other 4 of ⅢA thumbs underwent additional first web space release;All of ⅢB and Ⅳ thumbs underwent reconstruction of the thumb. Thumb function was evaluated, including abduction, opposition, pinch and comprehensive function. Results All 25 cases were followed up with an average of 19.9 months. The average thumb radial abduction angle was 61.0°;the average thumb palmar abduction angle was 68.8°;the verage Kapandji score was 7.4/10;the average thumb pinch score was 1.84/2;the average Goldfrab score was 3.12/4. Postoperative adhesion of the flexor tendon of the ring finger was found in 1case. Conclusions Modified Snow-Fink opposition transfer is recommended in the reconstruction of Blauth type Ⅱ to type Ⅳ congenital thumb hypoplasia with simple operation, less damage, and favorable functions, which is one of the surgical options to reconstruct the opposition function of congenital thumb hypoplasia.