中国修复重建外科杂志

中国修复重建外科杂志

一期拇对掌功能重建结合多边形皮瓣治疗先天性铲状手畸形

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目的探讨一期掌骨截骨、拇对掌功能重建结合多边形皮瓣治疗先天性铲状手畸形的临床疗效。 方法2013 年 1 月—2017 年 3 月收治铲状手畸形患儿 8 例。男 5 例,女 3 例;年龄 13~35 个月,平均 17.5 个月。患儿均表现为手指完全并指的“平板样”畸形,患手较健侧短小;所有对侧手均无异常,均未合并胸部、头颅、面部畸形。手术均采用掌骨截骨、拇指对掌功能重建并通过掌背矩形瓣重建虎口、多边形皮瓣旋转重建拇指指蹼及拇示指甲侧襞,拇指尺背侧及示指桡侧近节通过植皮修复。术后采用手功能评定专用游标卡尺测量患手虎口距离,拇指功能采取改良 Tada 评分评价。 结果8 例患儿对掌功能重建与虎口成形均一期完成,术后拇指尺背侧及示指桡侧植皮均成活。患儿均获随访,随访时间 13~29 个月,平均 16.1 个月。术后无皮瓣坏死、拇指侧偏、虎口挛缩等并发症发生。末次随访时所有患儿虎口区皮肤颜色与健侧无明显区别;患手虎口开大距离 3.5~5.0 cm,平均 4.2 cm;术后拇指功能采用改良 Tada 评分,获优 7 例、良 1 例,优良率 100%。术后拇指均可主动行抓握、对捏等动作,对掌功能良好。 结论一期拇对掌功能重建结合多边形皮瓣治疗先天性铲状手畸形术后手部功能改善良好,皮瓣设计合理能有效覆盖重要区域,手术安全可靠。

ObjectiveTo explore the effectiveness of one-stage metacarpal osteotomy, thumb opponensplasty and polygonal flap reconstruction in the treatment of congenital spade hand deformity. MethodsEight cases of congenital spade hand were treated between January 2013 and March 2017. There were 5 males and 3 females, with an average age of 17.5 months (range, 13-35 months). The clinical manifestations of all the children were congenital spade hand and the affected hand was shorter than the healthy side. The contralateral hand was normal and there was no chest, skull, or facial deformity. The operation was performed with metacarpal osteotomy and thumb opponensplasty, and through the dorsal metacarpal rectangular flap to reconstruct the first web and through rotation of polygonal skin flap to reconstruct thumb web and lateral fold of thumb index nail. The dorsal ulnar and proximal radial segment of thumb were repaired by skin grafting. A vernier caliper was used to measure the first web space and the thumb function was evaluated by modified Tada score. ResultsThe reconstruction of palmar function and the formation of first web were completed in one stage in 8 children. Skin grafting on the dorsal ulnar side of thumb and radial side of index finger survived after operation. All the children were followed up 13-29 months, with an average of 16.1 months. There was no infection, skin flap necrosis, lateral deviation of thumb, scar contracture, or other complications. At last follow-up, there was no significant difference in skin color between the healthy side and the first web of the affected hand. The opening distance of first web space was 3.5-5.0 cm, with an average of 4.2 cm. According to the modified Tada scoring system, the results were excellent in 7 cases and good in 1 case, with an excellent and good rate of 100%. The thumb could grasp and pinch actively, and the palm opposition function was good. ConclusionOne-stage thumb opponensplasty combined with polygonal flap for reconstruction of congenital spade hand deformity can improve hand function very well. The reasonable designing of skin flap can effectively cover important areas, and the operation is safe and reliable.

关键词: 先天性铲状手畸形; 掌骨截骨; 对掌功能重建; 虎口成形; 外科皮瓣

Key words: Congenital spade hand deformity; metacarpal osteotomy; thumb opponensplasty; the first web formation; surgical flaps

引用本文: 沈小芳, 印飞, 薛明宇, 余炯, 林伟枫, 芮永军. 一期拇对掌功能重建结合多边形皮瓣治疗先天性铲状手畸形. 中国修复重建外科杂志, 2019, 33(2): 199-202. doi: 10.7507/1002-1892.201804111 复制

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