先天性第四、五掌骨融合的改良分型及治疗策略  

Modified classification and treatment strategy of congenital fusion of the fourth and fifth metacarpal bones

作　　者：殷悦涵 田文[1] 赵俊会[1] 孙丽颖[1] 刘波[1] 钟文耀 张楠 Yin Yuehan;Tian Wen;Zhao Junhui;Sun Liying;Liu Bo;Zhong Wenyao;Zhang Nan(Department of Hand Surgery,Beijing Jishuitan Hospital,the Fourth Clinical Medical College of Peking University,Beijing 100035,China)

机构地区：[1]北京积水潭医院手外科,北京大学第四临床医学院,100035

出　　处：《中华手外科杂志》2021年第2期106-111,共6页Chinese Journal of Hand Surgery

基　　金：北京积水潭医院院级基金 (2019-YJ03);北京积水潭医院"学科新星"计划专项经费资助 (XKXX201818);国家重点研发计划-罕见病临床队列研究-精准医学研究专项 (2016YFC0901500)。

摘　　要：目的总结先天性第四、五掌骨融合的形态学和影像学特点,对现有分型系统进行改良,并提出相应的治疗策略。方法总结我科自2007年7月至2019年12月收治的37例(57侧)先天性第四、五掌骨融合病例,以融合方式为依据进行分型,兼顾掌骨融合程度、掌骨头间距、掌指关节脱位、掌骨短缩4个要素,将畸形分为基底融合、分散融合、汇聚融合、完全融合、反向融合5型,后将分散融合及会聚融合两型依据畸形严重程度,分为Ⅰ、Ⅱ、Ⅲ亚型,并提出相应的治疗策略。结果本组所有病例均可入组改良分型,其中基底融合19侧,分散融合Ⅰ型2侧,分散融合Ⅱ型4侧,分散融合Ⅲ型5侧,汇聚融合Ⅰ型4侧,汇聚融合Ⅱ型7侧,汇聚融合Ⅲ型8侧,完全融合7侧,反向融合1侧。所有畸形的治疗均与治疗策略相符,患手的外观和功能均得到一定程度的改善。结论改良分型具有系统化、规范化的优点,同时能与治疗策略形成良好的对应关系,并为总结临床经验和后期疗效随访提供基础。Objective To summarize the morphological and imaging characteristics of congenital fusion of the fourth and fifth metacarpal bones,improve the existing classification system,and put forward the corresponding treatment strategy.Methods From July 2007 to December 2019,37 patients with 57 sides of congenital fusion of the fourth and fifth metacarpal bones were treated in our department.According to the fusion method,considering metacarpal fusion degree,metacarpal head distance,metacarpophalangeal joint dislocation,metacarpal bone shortening,the deformities were divided into 5 types:basal fusion,decentralized fusion,convergent fusion,complete fusion and reverse fusion.According to the severity of the deformity,the decentralized fusion and convergent fusion were divided into subtypesⅠ,ⅡandⅢ,and the corresponding treatment strategies were put forward.Results All the cases could be classified into modified classification,including basal fusion in 19 sides,decentralized fusion typeⅠin 2 sides,decentralized fusion typeⅡin 4 sides,decentralized fusion typeⅢin 5 sides,convergent fusion typeⅠin 4 sides,convergent fusion typeⅡin 7 sides,convergent fusion typeⅢin 8 sides,complete fusion in 7 sides and reverse fusion in 1 side.The treatment of all deformities was consistent with the treatment strategy,and the appearance and function of the affected hand were improved to a certain extent.Conclusion The modified classification has the advantages of systematization and standardization,and it can form a good corresponding relationship with the treatment strategy,and provide the basis for summarizing clinical experience and follow-up in the later period.

关 键 词：手畸形 先天性 掌骨 融合 改良分型 治疗策略 

分 类 号：R687.3[医药卫生—骨科学]