先天性拇指尺偏畸形——区别诊治Delta三节拇指和指骨骨骺畸形

目的探讨两种类型先天性拇指远节尺偏畸形,即Delta三节拇指和远节指骨骨骺畸形的临床、病理、影像学特点及手术策略,并评价中期疗效。方法自2011年1月至2017年6月,我们共收治28例43拇先天性拇指尺偏畸形患儿,根据X线片表现分为两类:Delta三节拇指和远节指骨骨骺畸形。两种病理解剖类型经MRI和术中探查进一步确认。三节拇指通过切除Delta指骨、紧缩桡侧副韧带和克氏针固定治疗,骨骺畸形则对三角形或楔形骨骺行骨骺内截骨和克氏针固定。结果术后随访时间为25-91个月,平均47个月,23拇(53.5%)为Delta三节拇指,手术年龄平均16个月,指间关节尺偏角度从(40.3±9.7)。下降到(2.3±5.1)°(P=0.008);20拇(46.5%)为远节指骨骨肪畸形,手术年龄平均33个月,尺偏角度从(33.4±9.6)°下降到(5.4±8.5)°(P=0.019)。日本手外科协会(Japanese Society for Surgery of the Hand,JSSH)评分:优29拇,良13拇,中1拇。结论Delta三节拇指和指骨骨骺畸形是先天性拇指尺偏畸形的两种病理解剖类型,分别行Delta指骨切除或骨骺内截骨术,能显著矫正拇指尺偏,术后关节稳定,功能良好。为避免畸形骨骺被当作多余指骨误切而导致生长紊乱,须明确骨骺畸形不属于三节拇指,年幼儿分型不明时应推迟手术直至明确分型。

Congenital ulnar deviation of thumb-different diagnosis and treatment of Delta triphalangeal thumbs and phalangeal epiphyseal deformity

Objective To investigate the clinical,pathological,imaging features and surgical strategies of two types of congenital ulnar deviation of distal thumb,namely Delta triphalangeal thumbs and phalangeal epiphyseal deformity,and evaluate the mid-term clinical efficacy.Methods From January 2011 to June 2017,28 cases(43 thumbs)of congenital ulnar deviation of thumb were treated in our hospital.According to the X-ray findings,they were divided into two types:Delta triphalangeal thumbs and phalangeal epiphyseal deformity.The two pathoanatomical types were further confirmed by MRI and intraoperative exploration.The three-phalangeal thumb were treated by Delta phalangectomy,radial collateral ligament constriction and Kirschner wire fixation.For phalangeal epiphyseal deformity,the triangular or wedge-shaped epiphysis was osteotomy and Kirschner wire fixation.Results The follow-up period ranged from 25 to 91 months with an average of 47 months.23 thumbs(53.5%)were Delta triphalangeal thumbs.The average age of operation was 16 months.The ulnar deviation angle o￡interphalangeal joint decreased from(40.3±9.7)°to(2.3±5.1)°(P=0.008).20 thumbs(46.5%)were distal phalangeal epiphyseal deformity.The average operative age was 33 months.The ulnar deviation angle decreased from(33.4±9.6)°to(5.4±8.5)°(P=0.019).All the cases were evaluated by Japanese Society for Surgery of the Hand(JSSH)scoring system,and the results were excellent in 29 thumbs,good in 13 thumbs,and fair in 1 thumb.Conclusion Delta triphalangeal thumbs and phalangeal epiphyseal deformity are two kinds of pathoanatomical types of congenital thumb ulnar deviation.Delta phalangectomy or epiphyseal osteotomy respectively can significantly correct ulnar deviation of thumb,with stable joint and good function after operation.In order to avoid the abnormal epiphysis being treated as redundant phalanges and causing growth disorder,it is necessary to make sure that the deformity of epiphysis does not belong to three-phalangeal thumb.When the classification of young children is not clear,the operation should be postponed until the classification is clear.