趾列切除治疗儿童巨趾症  

Ray amputation for the treatment of macrodactyly of the foot in children

作　　者：陈露[1,4] 陈伟 田晓菲[3,4] Chen Lu;Chen Wei;Tian Xiaofei(Department of Ultrasound,Children’s Hospital of Chongqing Medical University,Chongqing 400014,China;Department of Orthopedics,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Burn and Plastic Surgery,Children’s Hospital of Chongqing Medical University,Chongqing 400014,China;National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院超声科,400014 [2]重庆医科大学附属第一医院骨科,400016 [3]重庆医科大学附属儿童医院烧伤整形科,400014 [4]国家儿童健康与疾病临床医学研究中心儿童发育疾病研究教育部重点实验室儿童发育重大疾病国家国际科技合作基地重庆市儿科学重点实验室,400014

出　　处：《中华整形外科杂志》2021年第9期962-967,共6页Chinese Journal of Plastic Surgery

基　　金：重庆市科卫联合项目(2020MSXM087);国家临床重点专科建设项目(国卫办医函(2013)544)。

摘　　要：目的探讨趾列切除治疗儿童巨趾症的临床效果及其适应证。方法回顾性分析2017年1月至2018年10月重庆医科大学附属儿童医院接受趾列切除治疗巨趾症患儿手术前后足部尺寸变化的临床及影像学资料。趾列切除指征(1项或多项):(1)跖骨累及;(2)前足肥厚明显;(3)伴有并趾;(4)进展型巨趾;(5)受累足趾序列靠后;(6)患儿及家属强烈要求切除趾列。术后随访24~40个月。采用跖骨间宽度比和跖骨扩散角来评价患足的严重程度及手术前后的尺寸变化。采用巨趾调查问卷评价临床效果。根据临床结果分析前述趾列切除指征对儿童巨趾症的适用性。手术前后跖骨间宽度比以M(P_(25),P_(75))表示,采用Wilcoxon符号秩检验进行分析;手术前后跖骨扩散角以均数±标准差表示,采用配对t检验进行分析。结果共纳入患儿15例(15足),其中男9例,女6例;年龄7~66个月,平均22个月;右足5例,左足10例。因跖骨受累切除趾列者9例,其中1例伴有并趾畸形;因前足增厚严重切除趾列者1例;因受累趾顺序靠后切除趾列者1例;因伴有并趾畸形切除趾列者3例;因患儿及家属强烈要求切除趾列者1例。15例中,第2趾列切除者8例,第3趾列切除者5例,第2、3趾列同时切除者2例。共有4例进展型巨趾。15例患儿术后足部体积均较术前明显缩小,跖骨间宽度比从1.14(1.07,1.29)降至0.91(0.84,1.01)(P=0.002),跖骨扩散角从(33.27±8.13)°降至(15.25±8.54)°(P<0.01)。所有患者术后左、右足均可穿同码鞋,其中9例不需鞋垫,其余6例患足较对侧正常足稍大,正常足侧需穿鞋垫。术后巨趾调查问卷评分为(9.2±0.8)分。结论趾列切除能最大限度缩小患足体积,达到较好的功能及外观重建效果。前述趾列切除指征对儿童巨趾症适用性良好,巨趾症患儿可根据患足临床表现、严重程度及特点、患儿和家属的意愿选择趾列切除。Objective To evaluate the clinical results and indication of ray amputation for the treatment of macrodactyly of the foot in children.Methods A retrospective analysis was carried out focusing on the clinical and radiographic data of 15 children with pedal macrodactyly who underwent ray amputation between January 2017 and October 2018 in Children’s Hospital of Chongqing Medical University.Indications for ray amputation were as follows(one or more):(1)the metatarsal involved;(2)grossly overgrowth of the forefoot;(3)accompany with syndactyly;(4)progressive type;(5)the affected toes near the fibular side;(6)the strong will of the patients and parents for ray amputation.Postoperative follow-up was 24 to 40 months.We administrated the intermetatarsal width ratio and the metatarsal spread angle to evaluate the severity of the macrodactyly and the effect of treatment.The questionnaire for foot macrodactyly was used to evaluate clinical results.And then,the applicability of ray amputation for the treatment of macrodactyly of the foot was analyzed based on the results.The intermetatarsal width ratio,which is described with M(P_(25),P_(75)),was compared pre-and post-operatively using Wilcoxon signed-rank test,while the metatarsal spread angle described with Mean±SD was compared pre-and post-operatively using the paired t-test.Results A total of 15 patients(15 feet)with macrodactyly of the foot were enrolled in the study(9 males and 6 females).The mean age of the patients was 22 months(range:7 months to 66 months).Five cases involved the right foot,and 10 involved the left foot.Ray amputation was performed on 9 cases(one with syndactyly simultaneously)for metatarsal involvement,1 case for overgrowth of the forefoot,1 case for the affected toes near the fibular side,3 cases for accompanying with syndactyly,1 case for a strong desire for surgery.The second ray was amputated in 8 cases,the third ray in 5 cases,and both the second and third ray in 2 cases.Four cases were progress macrodactyly.The size of the affected feet in

关 键 词：足畸形 巨趾症 趾列切除 外科 整形 

分 类 号：R726.8[医药卫生—儿科]