应用牵张延长法矫正单侧D型短指症的短甲畸形  

Application of distraction lengthening for correcting the short nail deformity in unilateral congenital brachydactyly type D

作　　者：蒋永康[1] 黄磊 王斌[1] 孙文海 Jiang Yongkang;Huang Lei;Wang Bin;Sun Wenhai(Department of Plastic and Reconstructive Surgery,Shanghai 9th People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院整复外科,上海200011

出　　处：《中华整形外科杂志》2023年第2期199-204,共6页Chinese Journal of Plastic Surgery

基　　金：上海市临床重点专科建设项目——整形外科(shslczdzk00901)。

摘　　要：目的观察牵张延长法矫正D型短指症短甲畸形的效果。方法回顾性分析2020年1月至2021年12月上海交通大学医学院附属第九人民医院整复外科采用牵张延长法治疗单侧D型短指症患者资料。术中于拇指末节骨干中段横向截骨,截骨线两侧各插入1枚螺钉,安装微型外固定支架,术后缓慢、持续延长末节指骨。通过外观测量和影像学检查,评估手术效果,并进行满意度调查。结果共纳入35例患者,男12例,女23例;平均年龄29.5岁;左侧拇指17例,右侧拇指18例。牵张延长时间为10~17 d,平均12.3 d;外固定架维持时间为55~70 d,平均61.4 d;平均随访时间18.6个月。患侧拇指指甲的长度从(9.2±0.6)mm增加到(14.2±0.4)mm(P<0.05),延长比率为(54.4±7.5)%;指甲长度/宽度比从0.63±0.05提升至1.05±0.04(P<0.05),增加比率为(68.2±10.5)%,与正常侧接近(1.07±0.03)(P>0.05)。拇指末节长度从(22.6±0.7)mm增加到(29.6±1.0)mm(P<0.05),增加(6.9±1.0)mm,增加比率为(30.8±4.8)%。指甲长度/拇指末节长度比从0.41±0.03提升至0.51±0.02(P<0.05),提升比率为(23.6±8.3)%。拇指指间关节活动度无明显变化(P>0.05)。94.3%(33例)的患者对手术效果满意。结论牵张延长法可以矫正D型短指症的短甲畸形,获得良好的美学外观和功能。Objective To describe the effect of distraction lengthening to correct nail deformity in unilateral congenital brachydactyly type D(BDD).Methods Patients with unilateral BDD who were treated by distraction lengthening between January 2020 and December 2021 in the Department of Plastic and Reconstructive Surgery of Shanghai 9th People’s Hospital were retrospectively reviewed.A transverse osteotomy was applied on the middle diaphysis of distal phalanx,and one pin was inserted percutaneously on both sides of the osteotomy site,then a mini external fixator was installed.Distraction lengthening was performed with a slow and sustained procedure.The aesthetic and functional results were compared preoperatively and postoperatively.Patient satisfaction questionnaires were recorded.Results 35 patients were enrolled,including 12 males and 23 females,with a mean age of 29.5 years.17 thumbs were left and 18 thumbs were right.The time for distraction lengthening was 10-17 days,and the mean time was 12.3 days.The total time for external fixator maintenance was 55-70 days,with a mean time of 61.4 days.The mean follow-up was 18.6 months.The mean thumbnail length was increased from(9.2±0.6)mm to(14.2±0.4)mm[lengthening ratio,(54.4±7.5)%]after distraction lengthening(P<0.05).The ratio of nail length to width changed from 0.63±0.05 to 1.05±0.04[increase ratio,(68.2±10.5)%,P<0.05],which was equal to the normal value(1.07±0.03)(P>0.05).Meanwhile,the distal thumb length increased from(22.6±0.7)mm to(29.6±1.0)mm(P<0.05),with a mean increase of(6.9±1.0)mm,and the increase ratio was(30.8±4.8)%.The ratio of nail length to distal thumb length changed from 0.41±0.03 to 0.51±0.02[increase ratio,(23.6±8.3)%,P<0.05].The thumb function was not significantly influenced(P>0.05).33 patients(94.3%)were very satisfied with the results.Conclusion Short nail deformity in BDD can be corrected by distraction lengthening with a good aesthetic appearance and without functional impairment.

关 键 词：拇指 D型短指症 指甲畸形 牵张延长 单侧 

分 类 号：R658.2[医药卫生—外科学]