尺侧拐棒手的临床表现和治疗策略  

Clinical manifestations and treatment of ulnar club hand

作　　者：郜永斌[1] 赵俊会[1] 陈山林[1] Gao Yongbin;Zhao Junhui;Chen Shanlin(Department of Hand Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院手外科,北京100035

出　　处：《中华医学杂志》2021年第35期2804-2808,共5页National Medical Journal of China

摘　　要：回顾北京积水潭医院于1966年至2016年治疗的13例16侧尺侧拐棒手患者的临床资料。记录患者的上肢骨骼放射学特征,以及肩、肘、前臂、腕及手部的外形与功能情况。通过桡骨截骨矫形、尺骨胚基切除、虎口开大、并指分指植皮,以及屈曲指松解植皮等术式对肢体畸形进行矫正。随访并记录患者或其家长对疗效的主观评价。结果发现,13例尺侧拐棒手患者中,男7例,女6例。双侧3例,右侧6例,左侧4例。平均年龄12.4岁(1~29岁)。根据Bayne分型,Ⅰ型4侧,Ⅱ型7侧,Ⅲ型4侧,Ⅳ型1侧。所有患肢均较正常短小。Ⅰ型畸形患者肘和腕关节稳定,活动度基本正常,手部没有明显畸形。Ⅱ型畸形患者肘关节稳定性差异较大,多伴有手部畸形。Ⅲ型畸形患者肘关节不稳定,多伴有手部畸形。Ⅳ型畸形患者肘关节融合,手部无明显畸形。9侧肢体实施了手术治疗。平均随访22.3个月(8~48个月),患者或家属的主观评价为满意或比较满意。尺侧拐棒手的手术治疗侧重于治疗手及前臂畸形,疗效较好。The medical records of 13 cases(16 limbs)diagnosed with ulnar club hand in Beijing Jishuitan Hospital between 1966 and 2016 were reviewed.The radiological characteristics of upper limb bones,the shape and function of shoulder,elbow,forearm,wrist,and hand were recorded.The surgical options include radial wedge osteotomy,ulnar anlage excision,release of syndactyly or narrowed first web,and release of camptodactyly were performed to correct deformities.The subjective evaluation of patients or their families was recorded.Thirteen patients with 16 affected limbs were identified with ulnar club hand.There were 7 males and 6 females with an average age of 12.4 years(range:1-29 years).Among them,3 cases were bilateral,and 10 cases were unilateral.Six patients had right-side involvement and 4 patients had left-side involvement.Based on Bayne′s classification,there were 4 typeⅠ,7 typeⅡ,4 typeⅢ,and 1 typeⅣ.The affected extremity was shorter than the normal limb.In patients with typeⅠdeformity,the elbows were stable with normal range of motion,the wrists were stable with almost normal range of motion,and the hands were normal.In patients with typeⅡdeformity,the stability of elbow was variable,and hand deformities were common.In patients with typeⅢdeformity,the elbows were unstable,and hand deformities were common.The elbow of the patient with typeⅣdeformity showed radiohumeral synostosis without hand deformity.Surgical treatment was performed on 9 limbs.Mean follow-up was 22.3 months(range:8-48 months),the subjective evaluation of patients or their families was satisfactory or relatively satisfactory.The surgical treatments of ulnar club hand usually focus on correction of hand and forearm deformities.The surgical result is good.

关 键 词：上肢畸形 先天性 尺侧拐棒手 尺侧纵向发育不良 

分 类 号：R658.2[医药卫生—外科学]