拇长屈肌腱转移软组织平衡技术治疗幼儿Wassel Ⅳ-D型多拇  

Soft tissue balance technique by flexor pollicis longus tendon transfer for Wassel Ⅳ-D thumb duplication in children

作　　者：任洪军 杨勇[2] 钟文耀 赵占卫 REN Hongjun;YANG Yong;ZHONG Wenyao;ZHAO Zhanwei(Department of Hand Surgery,Beijing Shuili Hospital,Beijing,100036,P.R.China;Department of Hand Surgery,Beijing Jishuitan Hospital,Beijing,100035,P.R.China)

机构地区：[1]北京水利医院手外科,北京100036 [2]北京积水潭医院手外科,北京100035

出　　处：《中国修复重建外科杂志》2022年第4期395-399,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨拇长屈肌(flexor pollicis longus,FPL)肌腱转移软组织平衡技术治疗幼儿WasselⅣ-D型多拇的疗效。方法 回顾分析2017年1月—2021年1月符合选择标准的14例WasselⅣ-D型多拇患儿临床资料。其中,男5例,女9例;年龄18-35个月,平均21.6个月。左侧10例,右侧4例。术中桡侧拇指切除后,将其FPL肌腱转移重建尺侧拇指软组织平衡。采用尺侧拇指指间关节(interphalangeal joint,IP)和掌指关节(metacarpophalangeal joint,MCP)被动屈曲、伸直活动度及骨关节力线(偏斜角度),以及重建拇指甲板宽度及IP水平周径与健侧拇指百分比,评价手术疗效。结果 所有手术均顺利完成,术后切口均Ⅰ期愈合。14例患儿均获随访,随访时间12-36个月,平均21.7个月。末次随访时,IP被动屈曲活动度、偏斜角度以及MCP偏斜角度均较术前改善(P<0.05);IP被动伸直活动度、MCP被动屈曲活动度与术前比较,差异无统计学意义(P>0.05);手术前后MCP被动伸直活动度均为0°。拇指甲板宽度为健侧的76.6%±4.1%,IP水平拇指周径为健侧的92.0%±9.1%。结论 采用FPL肌腱转移软组织平衡技术能有效纠正幼儿Wassel Ⅳ-D型多拇骨关节力线畸形,并有效维持矫正效果,但需进一步随访评价远期疗效。Objective To investigate the effectiveness of soft tissue balance technique by flexor pollicis longus(FPL) tendon transfer for Wassel Ⅳ-D thumb duplication in children. Methods A clinical data of 14 children with Wassel Ⅳ-D thumb duplication met the selection criteria between January 2017 and January 2021 was retrospectively analyzed. There were 5 boys and 9 girls with an average age of 21.6 months(range, 18-35 months). Ten cases were left hand deformity and 4 cases were right hand deformity. During operation, the radial thumb was excised, and the FPL tendon of the radial thumb was used to reconstruct the soft tissue balance of the ulnar thumb. Postoperative evaluation included the range of motion(ROM) of passive flexion and extension of the interphalangeal joint(IP) and metacarpophalangeal joint(MCP), the alignments of the IP and MCP, the percentage of the width of the nail plate and the circumference of the thumb at the level of the IP to contralateral thumb. Results All operations were completed successfully, and all incisions healed by first intention. The children were followed up 12-36 months(mean, 21.7 months).At last follow-up, the ROM of passive flexion and the deviation of the IP, and the deviation of the MCP significantly improved when compared with those before operation(P<0.05);the ROM of passive extension of the IP and the ROM of passive flexion of the MCP did not significantly improve when compared with those before operation(P>0.05). The ROMs of passive extension of the MCP were 0° before and after operation. The width of the nail plate was 76.6%±4.1% of the unaffected side, and the circumference of the thumb at the level of the IP was 92.0%±9.1% of the unaffected side.Conclusion The soft tissue balance technique by FPL tendon trasfer can effectively correct the alignment of the WasselⅣ-D thumb duplication in children, and maintain the correction effect effectively, but further follow-up and comprehensive evaluation are needed to investigate the long-term effectiveness.

关 键 词：WasselⅣ-D型多拇 软组织平衡技术 拇长屈肌 幼儿 

分 类 号：R726.8[医药卫生—儿科]