近节平面截骨的On-Top-Plasty术治疗特殊WasselⅥ型拇指多指畸形

Efficacy of On-Top-Plasty technique with proximal plane osteotomy for special Wassel Ⅵ thumb duplication

目的:探讨近节平面截骨的On-Top-Plasty术在特殊WasselⅥ型先天性多拇畸形治疗中的应用和疗效。方法:回顾性分析2012年1月至2020年12月于苏州瑞华骨科医院手外科治疗的8例9指特殊WasselⅥ型多拇指畸形患儿的临床资料。其中男5例,女3例;平均年龄为3.9岁,年龄范围在2.5~6.0岁。采用去除桡侧拇指发育不良的指骨(保留掌指关节)和尺侧拇指发育不良的掌骨(包括掌指关节),将尺侧指发育正常的组织移植至桡侧拇指的正常组织上,即重组桡侧拇指和尺侧拇指的正常组织,重塑一个相对外观、功能较好的拇指。结果:重组的8例9指全部成活,患儿于4~6周拔除克氏针,骨断端愈合良好。术后随访6~48个月,拇指外形美观,功能恢复良好。结论:采用近节平面截骨的On-Top-Plasty技术,将桡侧拇指和尺侧拇指的畸形部分拆分,再将桡侧拇指和尺侧拇指存留的部分进行重组修复,矫正拇指畸形。该手术方法简单易行,疗效切实可靠,是治疗此类拇指多指畸形的一种有效方法。

Objective To explore the efficacy of On-Top-Plasty technique with proximal plane osteotomy for special WasselⅥthumb duplication.Methods From January 2012 to December 2020,clinical data were reviewed for 8 children of special WasselⅥthumb duplication.Malplastic phalanx of radial thumb was removed with a preservation of metacarpophalangeal joint.Malplastic metacarpal bone of radial thumb(including metacarpophalangeal joint)were transplanted with normal tissue of radial thumb and ulnar thumb for reshaping a relatively decent and functional thumb.Results A total of 9 recombinant thumbs survived.Kirschner needle was removed after 4 to 6 weeks.Broken end of bones healed well.During a postoperative follow-up period of 6 to 48 months,thumb had a pleasant appearance and functions recovered well.Conclusions With the application of On-Top-Plasty technique with proximal plane osteotomy,radial thumb and ulnar thumb deformities may be partially dismantled.And the remainders of radial and ulnar thumb are properly re-organized.This operative mode is simple,practical and reliable with a definite curative effect.