复拇畸形术前拇指正位与斜位X线表现的差异及其临床意义  

Morphological differences and clinical significance of the antero-posterior and oblique X-ray appearance of the duplicated thumbs

作　　者：孔超 肖军[1] 李天武[1] 傅跃先[1] 邱林 田晓菲[1] Kong Chao;Xiao Jun;Li Tianwu;Fu Yuexian;Qiu Lin;Tian Xiaofei(Department of Burns and Plastic Surgery, 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烧伤整形科,儿童发育疾病研究教育部重点实验室,重庆市儿科学重点实验室,重庆市(儿童发育重大疾病诊治与预防)国际科技合作基地,400014

出　　处：《骨科临床与研究杂志》2021年第4期200-206,共7页Journal Of Clinical Orthopedics And Research

摘　　要：目的探讨复拇畸形术前拇指正位和斜位X线表现的差异及其临床意义。方法纳入重庆医科大学附属儿童医院烧伤整形科收治的复拇畸形患儿355例(复拇指391个)。男230例,女125例;年龄4个月~12岁3个月,中位年龄14个月;36例为双侧畸形。依据复拇畸形Wassel分型方法,患指包括Ⅰ型和Ⅱ型68个、Ⅲ型和Ⅳ型231个、Ⅴ型和Ⅵ型57个及Ⅶ型35个。术前行患儿双侧拇指正位和斜位X线检查,将复拇指两个体位X线骨关节表现进行比较,并与术中探查结果进行核对。结果37个Ⅰ型和Ⅱ型复拇指、56个Ⅲ型和Ⅳ型复拇指、22个Ⅴ型和Ⅵ型复拇指及15个Ⅶ型复拇指骨关节形态与拇指轴向在拇指正位与斜位X线像的表现不同。术中探查证实拇指正位X线表现与复拇指水平位骨关节特点更符合,拇指斜位X线表现与复拇指侧位骨关节特点更符合。结论复拇畸形拇指正位X线像能更准确地反映复拇指在桡、尺侧水平位的骨关节畸形,拇指斜位X线像可以较好地反映复拇指骨关节屈伸程度。术前行拇指正位和斜位X线检查对复拇畸形的手术治疗有指导意义。Objective To explore the morphological differences and clinical significance of the antero-posterior and oblique X-ray appearance of the duplicated thumbs.Methods Three hundres and fifty-five children with duplicated thumbs(391 duplicated thumbs)were prospectively studied.There were 230 male and 125 female with a median age of 14 months(ranged from 4 months to 12 years and 3 months).Bilateral deformities were found in 36 cases.According to the Wassel classification,there were 68 thumbs of typeⅠorⅡ,231 thumbs of typeⅢorⅣ,57 thumbs of typeⅤorⅥand 35 thumbs of typeⅦ.Preoperative anteroposterior and oblique X-ray views of bilateral thumbs were taken.The osteoarticular features were compared between the X-ray views in 2 positions,and were checked during the intraoperative exploration.Results Thirty-seven thumbs of typeⅠorⅡ,56 thumbs of typeⅢorⅣ,22 thumbs of typeⅤorⅥand 15 thumbs of typeⅦshowed different osteoarticular shapes and axial direction of the duplicated thumb on the anteroposterior and the oblique X-ray views.The anteroposterior X-ray views were confirmed to be more consistent with the osteoarticular features of duplicated thumb in horizontal position and the oblique X-ray image to be more consistent with the features in lateral position during intraoperative exploration.Conclusion The osteoarticular performances of duplicated thumbs in their anteroposterior and oblique X-ray views are different.The anteroposterior X-ray views reflects preferably the osteoarticular malformation on the horizontal position(from radial to ulnar side)of duplicated thumbs,and the oblique X-ray views could reflect the conditions of bending and stretch states of thumbs.The preoperative anteroposterior and oblique X-ray views of the duplicated thumb are necesory for the surgical treatment of duplicated thumbs.

关 键 词：手畸形 先天性 多指畸形 放射摄影术 外科手术 

分 类 号：R68[医药卫生—骨科学]