对拇指发育不良特点及合并症的临床观察  

Characteristics of thumb hypoplasia and its associated conditions

作　　者：白帆 刘畅[1] 李秋雅 陈山林[1] Bai Fan;Liu Chang;Li Qiuya;Chen Shanlin(Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China)

机构地区：[1]北京大学第四临床医学院北京积水潭医院手外科,100035

出　　处：《骨科临床与研究杂志》2021年第4期207-212,217,共7页Journal Of Clinical Orthopedics And Research

摘　　要：目的了解并分析拇指发育不良的疾病特征和相关合并症特点。方法对2015年1月至2018年12月在北京积水潭医院手外科住院治疗的127例(159侧)拇指发育不良患者病历资料进行回顾性调查。男女比例为1.54∶1,月龄(32.73±22.12)个月;左侧37例,右侧58例,双侧32例;按照Manske改良的Blauth分型,共有Ⅱ型12侧,ⅢA型19侧,ⅢB型44侧,Ⅳ型72侧,Ⅴ型12侧。统计分析患者的一般情况、拇指发育不良特点及合并其他疾病情况与特点。结果共65例(51.2%)有合并症;34例(26.8%)合并心脏或大血管疾病;31例(24.4%)合并其他四肢畸形;4例(3.1%)合并泌尿系统畸形;3例(2.4%)患者合并消化系统畸形;3例(2.4%)合并头面部畸形;1例(0.8%)患者合并其他系统疾病。共31例有综合征;其中27例患心手综合征;4例患VACTERL综合征。合并的肢体畸形中桡骨发育不良、尺桡骨近端融合、小指发育不良多发生于拇指发育不良同侧(分别为15/16侧,3/3侧,3/3侧在同侧);复拇畸形多发生于对侧(1/10侧在同侧)。不同性别间Manske分型(双侧患病者取重的一侧统计)差异无统计学意义(χ2=8.74,P=0.07)。单侧受累者中右侧患者的Manske分型较左侧更重(χ2=12.25,P=0.03)。不同性别及不同患侧的组间合并症累及系统数量差异无统计学意义(P>0.05)。不同Manske分型间合并症累及系统数量差异有统计学意义(P=0.04)。Ⅴ型组较ⅢB型组的合并症累及更多系统(原始P=0.003,调整后P=0.026)。合并桡骨发育不良或尺桡骨近端融合会增加其他合并症累及的系统数量(χ2=8.556,P=0.01)。结论拇指发育不良多见于男性、右侧,51.2%患者存在合并症。随着分型加重,合并症有累及更多系统的趋势。在诊断及治疗中,应在多学科合作中对患者进行全面检查及评估,以明确诊治相关合并症。Objective To investigate and analyze the characteristics of thumb hypoplasia and its associated conditions.Methods A retrospective analysis was performed on the medical records of 127 patients(159 sides)with thumb hypoplasia,with 1.54∶1 male/female ratio and an average age of 32.73±22.12 months,underwent surgery in Department of Hand Surgery,Beijing Jishuitan Hospital from January 2015 to December 2018.There were 37,58 and 32 hypoplastic thumbs on the left,right side and both sides.According to the Manske modified Blauth classification,there were 12 typeⅡ,19 typeⅢA,44 typeⅢB,72 typeⅣand 12 typeⅤhypoplasia thumbs.The general conditions,characteristics of thumb hypoplasia and its associated conditions were recorded and analyzed.Results 65(51.2%)patients had associated conditions;34(7.9%)had heart or great vessels diseases;31(24.4%)had anomalies of limbs;4(3.1%)had urinary anomalies;3(2.4%)had digestive anomalies;3(2.4%)had anomalies of head or face,and 1(0.8%)had anomalies of other systems.A total of 31 cases had associated syndromes,of which 27 cases had Holt-Oram syndrome and 4 cases had VACTERL syndrome.There was no statistically significant difference in Manske classification(the severer side was included in patients with bilateral thumbs involved)between different genders(χ2=8.74,P=0.07).The Manske classification of right-side patients was more severe than that of the left side(χ2=12.25,P=0.03).There was no statistically significant difference in the systems number that associated conditions involved between different genders and different affected sides(P>0.05).There was a statistically significant difference between different Manske classifications(P=0.04),The type V group had more associated-conditions-involved systems than type IIIB group(original P=0.003,adjusted P=0.026);When combined with radial hypoplasia or congenital radioulnar synostosis,the number of systems that other associated conditions involve increased(χ2=8.556,P=0.01).Conclusions Thumb hypoplasia had a male and right-side pre

关 键 词：拇指 骨发育不全 合并症 心手综合征 

分 类 号：R68[医药卫生—骨科学]