软组织平衡重建改善Wassel Ⅳ-D型复拇畸形外观及功能的短期随访研究  

Application of soft tissue balance reconstruction for improving the appearance and function of Wassel Ⅳ-D thumb duplication: a short-term follow-up study

作　　者：沈小芳[1] 薛明宇[1] 印飞[1] 余炯 林伟枫 芮永军[1] Shen Xiaofang;Xue Mingyu;Yin Fei;Yu Jiong;Lin Weifeng;Rui Yongjun(Department of Hand Surgery, Wuxi N0.9 People’s Hospital affiliated to Soochow University, Wuxi 214000, China)

机构地区：[1]苏州大学附属无锡九院小儿骨科,江苏无锡214000

出　　处：《中华小儿外科杂志》2019年第6期532-535,共4页Chinese Journal of Pediatric Surgery

基　　金：江苏省青年医学重点人才培养计划(QNRC2016171).

摘　　要：目的探讨靴形顺行岛状瓣结合肌腱韧带平衡重建在改善Wassel Ⅳ-D型复拇畸形外观及功能中的应用。方法2014年10月至2017年3月,共手术治疗20例Wassel Ⅳ-D型复拇畸形,手术采用带甲侧襞的顺行指动脉岛状皮瓣改善指体细小、甲侧襞不对称的外观,肌腱韧带平衡重建结合关节成形术预防重建指体再畸形。术后随访采用日本手外科学会(Japanese Society for Surgery of the Hand,JSSH)评分对所有重建拇指的外观及功能进行评价。结果所有患儿皮瓣无坏死情况发生,随访时间9~38个月,平均17.4个月。所有患儿重建拇指细小、甲侧襞不对称外观均得到改善,末次随访JSSH评分得分平均18.9分,优11例,良8例,中1例,无指体侧偏畸形复发。结论采用带甲侧襞的靴形顺行岛状瓣结合肌腱韧带重建治疗Wassel Ⅳ-D型复拇畸形,指体功能良好,外观优良。Objective To explore the effect of using shoe-shaped neurovascular island flap with tendon and ligament reconstruction for Wassel Ⅳ-D thumb duplication. Methods Twenty cases of Wassel Ⅳ-D thumb duplication underwent shoe-shaped neurovascular island flapping plus tendon ligament reconstruction from October 2014 to March 2017. The criteria of Japanese Society for Surgery of Hand (JSSH) Scoring System were utilized for assessing the cosmetic outcomes of Wassel Ⅳ-D thumb duplication reconstruction. Results All flaps survived. The average follow-up was 17.4 (9-38) months. Pulp and nail fold symmetry were improved in all cases. Nail width and pulp circumference were close to normal side. The outcomes of JSSH system were excellent (n=11), fair (n=8) and medium (n=1). And the average score was 18.9 during the last follow-up. Conclusions Using shoe-shaped neurovascular island flap plus tendon ligament reconstruction is both safe and effective for restoring the symmetry and function of Wassel Ⅳ-D thumb duplication.

关 键 词：外科皮瓣 手畸形 美学 

分 类 号：R726.5[医药卫生—儿科]