对非典型Wassel Ⅵ型重复拇指畸形的病理解剖结构与治疗策略的探讨  

Pathologic anatomic classification and treatment of atypical Wassel type Ⅵ thumb duplication

作　　者：南国新[1] 何波[1] 蔡文全[1] 储瑞亮 Nan Guoxin;He Bo;Cai Wenquan;Chu Ruiliang(Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Stem Cell Biology and Therapy Laboratory, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400014, China)

机构地区：[1]重庆医科大学附属儿童医院骨科二病房,儿童发育疾病研究教育部重点实验室,国家儿童健康与疾病临床医学研究中心,儿童发育重大疾病国家国际科技合作基地,重庆医科大学附属儿童医院儿研所干细胞实验室,儿科学重庆市重点实验室,400014

出　　处：《骨科临床与研究杂志》2021年第2期85-89,99,共6页Journal Of Clinical Orthopedics And Research

摘　　要：目的探讨非典型WasselⅥ型重复拇指畸形的病理解剖结构与治疗策略。方法2008年5月至2019年6月,重庆医科大学附属儿童医院骨科二病房共治疗非典型WasselⅥ重复拇指畸形46例,即桡侧拇指掌骨发育好,拇指畸形;尺侧拇指掌骨发育不良,拇指外观良好。其中男26例,女20例;平均手术年龄1.4岁(11个月~3.8岁)。在手术治疗时对其病理学解剖结构进行统计和分析,包括掌骨发育、长短,拇指大小,形状,指甲宽度,指屈肌腱及指伸肌腱的发育、走向等。结果46例病例中,尺侧拇指发育细小者6例,无1例指间关节发生偏斜,屈伸肌腱均缺如者5例;单纯屈肌腱缺如者3例;单纯伸肌腱缺如者7例。X线片显示,掌骨长度小于对侧1/3者38例,掌骨长度介于1/2~1/3者8例。近端细小呈锥形,直径约为桡侧拇指的2/3。46例桡侧拇指外观均向桡侧偏斜,34例指端较细小,14例3节指骨,5例屈曲畸形。46例中桡侧拇指均长于尺侧拇指约1~1.5 cm,指屈肌腱及指伸肌腱均存在。41例指端小于尺侧拇指、指甲窄于尺侧拇指;5例指甲宽度与对侧相当。拇短展肌止点均附着于桡侧拇指近节指骨基底桡侧。术后随访6个月~3年;1例随访4个月后失去随访。1例骨折延迟愈合;1例指间关节伸直障碍;1例掌指关节稳定性差。术后6个月采用Tada评分标准进行评价显示,优30例;良13例;差2例。结论非典型VI型重复拇指畸形除尺侧拇指掌骨发育不良的特点外,多数情况下尺侧拇指外观较好。在解剖结构方面多数有完整的指屈肌腱及指伸肌腱,极少数指屈肌腱及指伸肌腱缺如,或仅有屈肌腱而没有伸肌腱。根据手术移位截骨平面需要将其分为两种类型,即屈肌腱缺如型和屈肌腱完整型两种。手术治疗宜将尺侧拇指移位于桡侧拇指,至于在掌骨远端移位还是近节指骨平面移位需根据有无屈肌腱存在而决定。Objective To investigate the pathological anatomic structure and surgical treatment of atypical Wassel type VI thumb duplication.Methods From May 2008 to June 2019,a total of 46 patients with atypical Wassel type VI thumb duplication were treated in Department of Orthopaedics,Children's Hospital of Chongqing Medical University.There were 26 males and 20 females,aged from 11 months to 3.8 years,with an average operating age of 1.4 years.The pathological anatomic structure was analyzed during the operation.These include metacarpal development,length,thumb size,shape,nail width,extensor flexor tendon development,and orientation.Results among the 46 cases,6 cases had ulnar thumb with small size.There was no deviation of interphalangeal joint in 1 case.The flexor or extensor tendon was absent in 5 cases and the flexor tendon was absent in 3 cases.The extensor tendon was absent in 7 cases.X-rays showed 38 cases with metacarpal bone length less than 1/3 of the contralateral side,and 8 cases with metacarpal bone length between 1/2 and 1/3.The proximal end is small and tapered,about 2/3 of the diameter of the radial thumb.The appearance of the radial thumb was all oblique to the radial side in 46 cases.The tip of the finger in 34 cases was small;the phalanx in 14 cases was 3 phalanxes;and the flexion deformity in 5 cases.The radial thumb in 46 cases was about 1-1.5 cm longer than the ulnar thumb.Flexor and extensor tendons were present in all the cases.The finger tip in 41 cases was smaller than the ulnar thumb;the fingernail was narrower than the ulnar thumb;and the width and width were similar in 5 cases.The insertion point of abductor pollicis was attached to the radial base of the proximal phalanx of the thumb.Patients were followed up for 6-36 months;and 1 patient was not followed up after 4 months.One case had delayed fracture healing;one had interphalangeal joint extension disorder;and one had poor metacarpophalangeal joint stability.According to the Tada scores,the outcomes of the cases were good in 30 patients,fa

关 键 词：手畸形 拇指 骨疾病 发育性 修复外科手术 

分 类 号：R68[医药卫生—骨科学]