摘要
目的探讨先天性V型复拇指畸形的手术治疗方法及疗效。方法 2010年3月-2015年5月,收治12例先天性V型复拇指畸形患者。男7例,女5例;年龄1~25岁,平均8岁。左手4例,右手8例。桡侧为主型2例,尺侧为主型10例。7例赘生指基底远离腕掌关节,5例赘生指基底靠近腕掌关节（略尺偏1例）。X线片示主干拇指第1掌骨与大多角骨均对合良好,伴第1掌骨侧弯畸形2例。术前制定个体化治疗方案,作S形或Z形切口,切除赘生指,同时重建大鱼际肌止点或内收肌止点,必要时联合楔形截骨术矫形。结果术后患者切口均Ⅰ期愈合。术后12例均获随访,随访时间6~24个月,平均12个月。11例拇指外形、屈伸、对掌、外展功能均较术前改善,未出现瘢痕挛缩畸形、虎口区狭小及偏斜畸形等情况。1例虎口区略狭小,拇指外展不良,经再次＂Z＂字成形术后改善。末次随访时,根据中华医学会手外科分会上肢部分功能评定试用标准评定患指功能：优10例,良1例,差1例;优良率91.7%。结论根据V型复拇指畸形情况制定个体化手术方案,可较好恢复拇指外形及功能。
Objective To study the effectiveness of surgical treatment of congenital type V thumb syndactyly. Methods Between March 2010 and May 2015, 12 cases of congenital type V thumb syndactyly were treated. There were 7 males and 5 females, aged from 1 to 25 years（mean, 8 years）. The right thumb was involved in 8 cases, and the left thumb in 4 cases. There were 2 cases of radial type, and 10 cases of ulnar type. The basement of polydactylism was far away from the carpometacarpal joint in 7 cases, and was close to the carpometacarpal joint in 5 cases（slight ulnar deviation in 1 case）. X-ray films showed that the main first thumb metacarpal bone and trapezium fitted well, and 2 cases had the first metacarpal bone deformity. Preoperative individualized treatment plan was made, and polydactylism was excised by the ＂S＂ or ＂Z＂ incision and simultaneous reconstruction of thenar muscle insertions or adductor muscle insertions was performed; if necessary, wedge osteotomy was used for correction. Results All incisions healed by first intention with no complication. All cases were followed up 6 to 24 months（mean, 12 months）. The thumb appearance, flexion and extension, the function of opposition, abduction function were improved significantly in 11 cases with no scar contracture deformity, small first web space, and deviation deformity. One case had slightly narrow first web space. According to hand function criterion, the results were excellent in 10 cases, good in 1 case, poor in 1 case; excellent and good rate was 91.7%. Conclusion Based on the condition of the type V thumb syndactyly, the individualized treatment plan is made, which can better restore the shape and function of the thumb.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2016年第9期1127-1129,共3页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家临床重点专科基金资助项目(国卫办医函[2013]544)~~
关键词
V型复拇指畸形
手功能
外科手术
Type V thumb syndactyly
Hand function
Surgical procedure
