重复拇指畸形矫正术后继发偏斜畸形的临床研究  

CLINICAL RESEARCH OF POSTOPERATIVE DEVIATION SECONDARY TO THUMB DUPLICATION RESECTION

作　　者：殷耀斌[1] 田文[1] 赵俊会[1] 田光磊[1] 

机构地区：[1]北京积水潭医院手外科,北京100035

出　　处：《中国修复重建外科杂志》2014年第7期835-839,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：北京市卫生局"十百千"人才"十层次"专项基金(2012)资助项目;首都临床特色应用研究资助项目(131107002213124)~~

摘　　要：目的探讨重复拇指畸形矫正术后继发偏斜畸形的原因及治疗方法。方法回顾分析2007年2月-2013年6月收治的32例（33侧）重复拇指畸形矫正术后继发偏斜畸形患者临床资料。男13例,女19例;年龄2-34岁,中位年龄8岁。左侧7例,右侧24例;双侧1例。重复拇指畸形参照Wassel分型标准,Ⅱ型2侧,Ⅲ型4侧,Ⅳ型10侧,Ⅴ型7侧,Ⅶ型10侧。多指切除术距该次入院时间1-29年,平均6.5年。拇指单纯掌指关节尺偏9侧,单纯指间关节桡偏8侧、尺偏10侧,掌指关节尺偏合并指间关节桡偏6侧。掌指关节偏斜20-40°,平均32.3°;指间关节偏斜30-110°,平均42.5°。根据手指偏斜畸形不同程度,选择个体化矫形方式,包括切除异常残留的骨或软骨,重建拇指正常轴线及软组织平衡。结果术后切口均Ⅰ期愈合,无手术相关并发症发生。32例均获随访,随访时间6-70个月,平均34个月。X线片复查示,骨骼轴线均改善;截骨处均获骨性愈合,愈合时间5-10周,平均6周。术后31例（31侧）拇指偏斜完全矫正;1例（双侧）术前偏斜角度过大者,术中未完全矫正,术后遗留偏斜角度10°。13侧手指关节活动度同术前,20侧活动度较术前下降,但未明显影响手指功能。19例（20侧）随访2年以上者无偏斜畸形复发,拇指发育良好,但14例（14侧）拇指外观小于健侧。结论重复拇指畸形矫正术中需重建拇短展肌止点,对屈、伸拇长肌腱止点移位重建及必要的截骨矫形可避免术后偏斜畸形发生;对偏斜畸形应根据畸形程度及导致畸形的原因选择个体化矫形方式。Objective To study the causes and treatment of postoperative deviation secondary to thumb duplication resection. Methods Between February 2007 and June 2013, 32 cases（33 thumbs） of postoperative deviation secondary to thumb duplication resection were treated, and the clinical data were retrospectively analyzed. There were 13 males and 19 females, aged 2-34 years（median, 8 years）. The left thumbs were involved in 7 cases, the right thumbs in 24 cases, and bilateral thumbs in 1 case. Of 33 thumbs, 2 were rated as type II, 4 as type III, 10 as type IV, 7 as type V, and 10 as type VII according to Wassel classii cation. The average time between duplicated thumb resection and admission was 6.5 years（range, 1-29 years）. Nine thumbs only had ulnar deviation of the metacarpophalangeal（MP） joint; 8 thumbs only had radial deviation of the interphalangeal（IP） joint; 10 thumbs only had ulnar deviation of the IP joint; and 6 thumbs had ulnar deviation of the MP joint combined with radial deviation of the IP joint. The mean deviation degree of the MP joint was 32.3°（range, 20-40°）, and the mean deviation degree of the IP joint was 42.5°（range, 30-110°）. Operation methods were chosen specially according to the deformity, including remnant bone or cartilage resection, restoring normal alignment, and soft tissue balance. Results All wounds got i rst stage healing and there was no complication associated with operation. Postoperative follow-up period ranged from 6 to 70 months（mean, 34 months）. The skeleton alignment of the thumbs was improved on the X-ray images; all osteotomy got union at 5-10 weeks（mean, 6 weeks）. Deviation was completely corrected in 31 thumbs; the preoperative deviation degree was too large to correct completely in 2 thumbs with a postoperative deviation degree of 10°. The motion degree was similar to that at preoperation in 13 thumbs; the motion degree decreased in 20 thumbs, which did not af ect the function of the thumbs. Nineteen cases（20 thumbs） were followed

关 键 词：重复拇指畸形 偏斜畸形 并发症 畸形矫正 

分 类 号：R687.3[医药卫生—骨科学]