中国修复重建外科杂志

中国修复重建外科杂志

小儿指间关节融合型复拇畸形的诊治体会

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目的 探讨小儿指间关节融合型复拇畸形的诊断及治疗方法。 方法 2013 年 1 月—2017 年 5 月,收治 7 例小儿指间关节融合型复拇畸形。男 5 例,女 2 例;年龄 10 个月~11 岁,平均 3.1 岁。左侧 4 例,右侧 3 例。患儿均经 MRI 检查确诊,可见桡侧多指基底与近节指骨关节面以软骨相连。行桡侧多指切除、侧副韧带止点重建、近节指骨截骨矫形内固定。 结果 手术均顺利完成,术后无感染、皮瓣坏死等早期并发症发生。患儿均获随访,随访时间 6~23 个月,平均 14.1 个月。末次随访时,指体无偏斜、瘢痕挛缩等情况发生,指间关节背伸活动无受限,屈曲活动度为 20~75°,平均 56.7°。采用日本手外科协会(JSSH)评分评价重建拇指的外观及功能,获优 3 例、良 4 例,优良率 100%。 结论 小儿指间关节融合型复拇畸形可结合临床表现、X 线片及 MRI 检查确诊,通过侧副韧带止点重建结合截骨内固定治疗能获得满意疗效。

Objective To investigate the diagnosis and treatment of thumb polydactyly with symphalangism in children. Methods Seven cases of thumb polydactyly with symphalangism were treated between January 2013 and May 2017. There were 5 males and 2 females, aged from 10 months to 11 years, with an average age of 3.1 years. The children were diagnosed with MRI and it was seen that the base of radial multi-finger and the proximal phalangeal joint were connected by cartilage. All patients were treated with resection, lateral collateral ligament reconstruction, bone osteotomy and internal fixation. Results The operation was successfully completed, and there was no early complications such as infection and flap necrosis. All patients were followed up 6–23 months (mean, 14.1 months). At last follow-up, there was no deformity finger, scar contracture, and other complications. The extension of the interphalangeal joint was no limited, and the range of flexion of the interphalangeal joint was 20-75°(mean, 56.7°). The appearance and function of the thumb was rated as excellent in 3 cases and good in 4 cases by Japanese Society for Surgery of the Hand Scoring (JSSH), with the excellent and good rate of 100%. Conclusion The thumb polydactyly with symphalangism in children can be combined with clinical manifestations, X-ray film, and MRI examination to diagnose, and can obtain satisfactory results through the reconstruction of lateral collateral ligament, bone osteotomy and internal fixation.

关键词: 指间关节融合型复拇畸形; 先天畸形; 韧带重建; 内固定; 儿童

Key words: Thumb polydactyly with symphalangism; congenital malformation; ligament reconstruction; internal fixation; children

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