先天性扣拇指畸形的病理解剖学特点及个性化治疗  

The pathoanatomy features of congenial clasped thumb and the individual-based treatment

作　　者：张辉[1] 王彦生[1] Zhang Hui;Wang Yansheng(Department of Hand Surgery,Affiliated Central Hospital of Shenyang Medical College,Shenyang 110024,China)

机构地区：[1]沈阳医学院附属中心医院手外科,110024

出　　处：《中华整形外科杂志》2020年第7期739-742,共4页Chinese Journal of Plastic Surgery

摘　　要：目的探讨先天性扣拇指畸形的病理解剖学特点、个性化治疗方案及临床治疗效果。方法2004年1月至2019年12月沈阳医学院附属中心医院收治先天性扣拇指畸形患者23例,男15例,女8例。就诊年龄8个月至11岁,平均3.3岁。23例共42只手,参照Tsuyuguchi分型,其中Ⅰ型4只手,Ⅱ型22只手,Ⅲ型16只手。依据分型及病理解剖学特点给予个性化治疗。术式:松解第1指蹼应用皮肤改形术或示指背外侧皮瓣转移术。松解掌指关节应用拇短屈肌深头及拇收肌横头节段性肌内腱离断术。重建拇指功能应用示指固有伸肌腱或环指屈指浅肌腱移位术。术后随访参考Gilbert的多标准评价体系观察评价拇指位置及外观、掌指关节稳定程度、拇指对指能力及父母满意度。结果平均随访12.3个月,参考Gilbert多标准评价体系,拇指位置及外观优良率71.4%(30/42);掌指关节稳定程度优良率78.6%(33/42);拇指对指能力优良率73.8%(31/42);父母满意度83.3%(35/42)。结论按先天性扣拇畸形的不同类型及病理解剖学特点采取个性化治疗方案,效果满意。Objective To investigate the pathological anatomical features of congenial clasped thumb,the individualized treatment and the clinical therapy effects.Methods From January 2004 to December 2019,23 patients with congenial clasped thumb,including 15 males and 8 females,were admitted to the Affiliated Central Hospital of Shenyang Medical College.The age ranged from 8 months to 11 years,with an average of 3.3 years.Forty two affected hands of 23 patients were recruited in this study.According to the Tsuyuguchi’s classification,4 were graded as typeⅠ,22 were graded as typeⅡ,16 were graded as typeⅢ.All patients were given individual-based treatment according to the classification and the pathoanatomy features.Surgical method:To release the thumb web space,dermoplasty or index finger dorsolateral flap transplantation was applied.To release metacarpophalangeal joint,the deep head of flexor pollicis brevis and transverse head of adductor pollicis were performed with segmental intramuscular tendon dissociation.To reconstruct the thumb function,the entensor indicis or the FDS of the ring finger was transferred.The excellent and good rate of postoperative follow-up was higher than 70%.Results All cases were followed up for a mean period of 12.3 months.According to Gilbert’s assessment of thumb function,excellent and good rate of position and appearance of thumb was 71.4%(30/42),metacarpophalangeal joint stability was 78.6%(33/42),of thumb opposability was 73.8%(31/42).The satisfaction rate of parents was 83.3%(35/42).Conclusions Individual-based treatments of congenial clasped thumb according to the classification and the anatomical features achieved satisfactory efficacy.

关 键 词：先天畸形 拇指 病理解剖学 

分 类 号：R658.2[医药卫生—外科学]