顶端移位术联合轴形皮瓣在非典型WasselⅥ型复拇畸形中的应用

Efficacies of treating atypical Wassel typeⅥthumb duplication with on-top-plasty plus axial flap

目的探讨应用顶端移位术联合轴形皮瓣治疗非典型WasselⅥ型复拇畸形的临床疗效。方法回顾性分析2016年8月至2020年8月于西安交通大学医学院附属红会医院治疗的6例非典型WasselⅥ型复拇畸形患儿的临床资料。其中男5例,女1例;平均年龄为25个月,范围在18~35个月;患侧位于左侧3例,右侧3例。采用顶端移位术联合轴形皮瓣重建患儿拇指。术后对患儿持续随访,末次随访使用日本手外科学会评分标准对患儿手指评分,测量重建指掌骨的长度,并计算其与正常侧掌骨长度的百分比;测量重建指指间关节及掌指关节平面周径,并计算其与正常指对应平面周径的百分比。结果所有患儿均获得随访,术后随访30~45个月,平均随访37个月,轴形皮瓣均存活,无坏死,掌指关节及指间关节无粘连,术后表现出良好的抓、捏功能。末次随访时日本手外科学会评分优3例,良3例。重建指掌骨的长度占正常侧掌骨长度百分比的平均值为87%,重建指指间关节及掌指关节平面周径占正常指对应平面周径百分比的平均值分别为100%和102%。结论应用顶端移位术联合轴形皮瓣治疗非典型WasselⅥ型复拇畸形具有良好的临床效果。

Objective To explore the clinical efficacies of on-top-plasty plus axial flap for childrens with atypical Wassel typeⅥthumb duplication(polydactyly).Methods From August 2016 to August 2020,6 children of atypical Wassel typeⅥthumb duplication were reviewed retrospectively.There were 5 boys and 1 girl with an average age of 25(18-35)months.The involved side was left(n=3)and right(n=3).Reconstruction of thumb was performed with on-top-plasty plus axial flap.According to the JSSH scoring system,length of reconstructed metacarpal bone was compared with contralateral thumb.And girths of reconstructed thumb were measured at the levels of metacarpophalangeal and interphalangeal joints and compared to contralateral counterparts at the last follow-up.Results During an average follow-up period of 37(30-45)months,all axial flaps survived without necrosis.Motions at metacarpophalangeal and interphalangeal joints showed no restriction and both gripping and pinching were excellent.According to the JSSH scoring system,the outcomes were excellent(n=3)and decent(n=3).The average length of reconstructed thumb relative to contralateral thumb was 87%.As a percentage of contralateral thumb,average girth of reconstructed thumb was 102%at metacarpophalangeal joint and 100%at interphalangeal joint.Conclusions For atypical Wassel typeⅥthumb duplication in children,on-top-plasty plus axial flap are efficacious.