利用漂浮指矫正复拇指畸形

<正>复拇指畸形是常见的拇指先天畸形,但有漂浮指的复拇指畸形比较少见,笔者收治1例有漂浮指的复拇指畸形,其原位拇指发育不良,漂浮指外形接近健侧拇指,但无活动功能,通过手术将漂浮指与畸形的拇指合成为外形及功能接近正常的拇指,取得了比较满意的效果,现报道如下。1病例介绍某男,27岁。主因右手先天性拇指多指畸形27年,于2008年7月住院。系统查体未见异常。专科检查:右手可见6指,在右侧拇指正常位置上,有一     

复拇指畸形的分型及手术治疗的术式

先天性拇指畸形是最常见的手部先天性畸形，其治疗目的在于改善拇指的外形和功能。多拇指畸形是由拇指多种异常结构所组成：漂浮拇指，拇指发育不良，拇指内收畸形，关节偏斜，拇指伸指力弱和关节不稳定等。综述有关文献，并结合我院治疗拇指畸形的经验，对复拇指畸形的分...     

复拇指畸形治疗中骨关节的处理

目的 报告复拇指畸形治疗中骨关节的处理疗效.方法 对52例65指复拇指畸形的患者,针对不同类型,采用截骨关节矫形、侧副韧带肌腱修复重建和指套状瓣修复存留指等方法进行治疗,术后随访观察拇指关节外形和功能恢复情况.结果 术后随访到38例47指,随访时间为5个月至9年,其中4例4指术后出现不同程度的畸形,经过2次手术后,得到良好矫正.其余43指,术后拇指外形和功能均得到了明显改善,优良率为91.5%.结论 复拇指畸形治疗中,关节的处理是矫形手术的关键,如处理不当会导致术后继发性畸形.     

儿童Ⅵ～Ⅶ型复拇指畸形的显微外科组合治疗

目的探讨儿童先天性特殊类型Ⅵ～Ⅶ型复拇指畸形的显微外科组合治疗方法。方法 2009年3月-2016年7月,采用赘生拇指指血管神经蒂的指移位矫形主干拇指10例,其中9例赘生拇指掌骨一同切除,并重建拇内收肌止点。结果 10例术后均获3～24个月随访,外形改善,骨轴线正常,矫形拇指指体接近正常指,矫形拇指对指及外展功能正常。虎口开大4～6cm,矫形拇指感觉正常。结论通过显微外科的组合方法将主干拇指和赘生拇指合二为一,恢复矫形拇指和虎口外形及功能,是矫正先天性Ⅵ～Ⅶ型复拇指畸形的一种有效途径。     

两指不同组织组合矫正Ⅵ型复拇指畸形

手指先天性畸形较多见，复拇指畸形是先天多指畸形中常见类型之一，其发生率为0．08‰～0．18‰，复拇畸形有多种类型。我科自2003年以来收治8例特殊Ⅵ型复拇畸形患者。手术采取两指不同组织移位组合矫正复拇指，功能和外形得到改善，减少术后再次发生畸形，疗效满意，报道如下。     

复拇指畸形矫治术后的继发性畸形

目的探讨先天性复拇指畸形手术后的继发性畸形和处理方法。方法．对12例先天性复拇指畸形经矫治术后出现拇指侧偏、内收、虎口狭窄、骨骺残留等继发性畸形的患者，进行拇指指间关节融合、掌骨截骨、骨骺切除、虎口成型、拇短展肌止点重建等手术；以纠正畸形、改善拇指的外形及功能。结果术后随访3至6个月，除1例较术前稍有改善外，11例拇指的外形明显改善，拇指对掌、对指功能基本恢复。结论先天性复拇指畸形单纯手术切除后又出现继发性畸形，和过早(2岁以前)手术有关。患儿手指细小，组织结构辨认不清，可导致畸形矫治不彻底而出现继发性畸形。作者认为复拇指畸形的手术时机在2—6岁为好，畸形复杂者在学龄前手术为佳。     

复拇指畸形的临床治疗进展

复拇指畸形是一种常见的手部先天性畸形，国际手外科协会将其划入“孪生畸形”或“多指畸形”的范畴，发病率为0．08％o～0．18‰_l。]。拇指在仝手功能中约占40％，所以在先天性复拇指畸形治疗中拇指功能与外形的修整非常重要。本文就复拇指畸形的分型与手术治疗、特殊检查在诊断中的作用及术后继发畸形的原因等方面作简要综述。     

复拇指畸形矫形术后继发畸形15例的临床治疗

目的探讨先天性复拇指畸形术后出现的继发畸形及处理方法。方法对15例先天性拇指多指畸形经矫形术后残留拇指偏斜,虎口狭窄,瘢痕挛缩,骨、软骨及骨骺残留,韧带及动力系统不均衡等继发性畸形的患者,进行切除异常残留骨、软骨组织,截骨矫形等重建拇指正常轴线;肌腱修复或转位等重建动力系统平衡;彻底松解挛缩的瘢痕组织、虎口开大等改善拇指的外形及功能的治疗。结果术后随访12-36个月,本组15例均保留拇指外形,且功能明显改善。结论先天性复拇指畸形早期矫形手术后继发畸形,与手术时机及方式的选择、术者操作水平等因素有关,再次有效地矫形手术能纠正畸形、改善拇指功能。     

先天性拇指疾病的疗效分析

目的：介绍先天性拇指疾病的治疗效果。方法：1988年起,对56例先天性拇多指畸形,先天性拇板机指及先天性拇巨指症进行手术治疗。采用拇指赘生指切除、副指皮瓣转移,多拇残端修整术治疗拇多指畸形;巨指截指及整形术治疗巨指症;增厚狭窄腱鞘切除术治疗先天性拇板机指。结果：术后随访2－10年。（1）先天性拇指多指畸形：主干拇指外形改善,拇外展充分,对指功能良好。（2）拇指板机指：拇指伸屈自如,发育满意。（3）先天性巨指症1例：示、中指巨指切除,拇指远节截除,近节缩短整形,术后外形欠佳。结论：先天性拇指多指畸形应根据具体情况选择手术方式,以改善畸形、恢复拇指功能。先天性板机指明确诊断手术疗效佳。先天性巨指症采用截指方法较为理想。     

带血管神经束的多指移位修复拇指外形的临床应用

目的 探讨在拇指先天性多指切除矫形中将废弃赘生多指携带的血管神经束移位修复畸形拇指外形的临床应用和效果. 方法 2005年1月至2011年12月间,对6例拇指Ⅵ型多指畸形的治疗中,切除纤细和畸形的主干拇指末端部分,将生长在虎口处外形较好的赘生指截除掌骨后携带血管神经束经虎口、拇指尺侧方移位到主干拇指的末节进行固定,矫正拇指末节的外形.赘生指移位后同时进行虎口成型. 结果 转移的6例拇指全部成活,4周拔除克氏针,骨断端在4～6周愈合,术后随访3个月～1年,移植拇指外形美观,拇指指腹具有原有位置的感觉,拇指抓握、对指功能良好. 结论 应用显微外科技术将本应废弃的多指携带血管神经束进行移位修复主干拇指畸形,该手术方法简单易行,术后效果可靠满意,可临床推广和应用.     

Bilhaut-Cloquet术治疗复拇畸形的临床效果和常见并发症分析

目的 评价Bilhaut-Cloquet术治疗先天性复拇指畸形的临床效果,探讨分析其常见并发症的原因.方法 2006年至2009年,对15例先天性复拇指畸形患儿分别采用经典和改良Bilhaut-Cloquet术进行治疗,随访观察术后并发症并对疗效进行评价.结果 术后15例获得1～20个月的随访,平均6个月.参照Kawabata评分标准:采用经典Bilhaut-Cloquet术者5例,优1例,良3例,差1例;采用改良Bilhaut-Cloquet术者10例,优6例,良3例,差1例.两组中指甲畸形明显者9例,瘢痕挛缩、增生者5例.结论 Bilhaut-Cloquet术是治疗复拇指畸形的有效治疗术式,适合于Ⅰ型对等型多拇;Ⅱ型以上的多拇采用改良Bilhaut-Cloquet术更有利于指间关节(IP)关节活动度的恢复.除了重视关节活动度、稳定性和侧偏畸形的矫正外,指体外观尤其是指甲的精确重建应当得到进一步的重视.

Abstract：

Objective To evaluate the clinical outcomes of Bilhaut-Cloquet surgical procedure for the treatment of thumb duplication, and investigate the causes of common complications. Methods Bilhaut-Cloquet procedure and modified Bilhaut-Cloquet procedure were carried out in 15 children with congenital thumb duplication during 2006 to 2009. The patients were follow-up postoperatively to observe any complications and assess the results using Kawabata evaluation criterion. Results The 15 children were follow-up for 1 to 20 months (6 months on average) postoperatively. According to Kawabata evaluation criterion, the Bilhaut-Cloquet procedure achieved excellent results in 1 cases, good in 3 cases, and poor in 1 cases. Modified Bilhaut Cloquet procedure achieved excellent results in 6 cases, good in 3 cases, and poor in 1 case. Nine cases had apparent nail deformity and 5 cases were accompanied by cicatricial contracture and hyperplasia. Conclusion The Bilhaut-Cloquet technique is an effective procedure for the treatment of thumb duplication, especially suitable for type Ⅰ thumb duplication. Modified Bilhaut-Cloquet procedure is more conducive to the recovery of IP range of motion when used in type Ⅱ or more severe thumb duplication. Besides joint range of motion, stability, and correction of lateral deviation, appearance of the thumb especially accurate nail restoration should acquire more attention.     

Alumina ceramic prosthesis arthroplasty of the metacarpophalangeal joint in the rheumatoid hand. A 2-4-year follow-up study

Swanson's finger implant is being widely used to improve deformity of the thumb and finger and to restore function in the rheumatoid hand. Breakage of the implant and implant synovitis have been the most troublesome complications. The authors developed an alumina ceramic finger prosthesis to lessen these complications. This prosthesis was used for the metacarpophalangeal joint in 5 cases of flexion deformity of the thumb and in 21 cases (82 digits) with ulnar drift deformity. These cases were followed for 24-62 months (average, 38 months). Postoperative extension of the thumb was limited to 18 degrees and flexion was 48 degrees, on average. Postoperative range of motion was 30 degrees. The average limitation of extension of all digits was 18 degrees, and the average flexion was 54.5 degrees. The average range of motion was 36.5 degrees. Flexion deformity of the metacarpophalangeal joint of the thumb disappeared after operation, and ulnar drift was reduced to less than 10 degrees deviation in 87.8%. No dislocation or fracture of the prosthesis has been found on roentgenologic examination during short-term follow-up study. This prosthesis is useful for reducing deformity of the thumb and the finger in the rheumatoid hand. Postoperative extension of the metacarpophalangeal joint, however, has been unsatisfactory. The design of the prosthesis should be improved so that the rotational center of the metacarpophalangeal joint is located palmarly.     

示指拇化治疗重度拇指发育不全

目的 介绍示指拇化治疗先天性重度拇指发育不全(ⅢB～V型)的手术方法.方法 对Ⅳ型(漂浮拇)2例、ⅢB型(腕掌关节缺如)2例采用示指拇化,将示指自掌骨部位转位重建拇指.结果 4例移位指全部存活.术后随访2～3年,虎口开大70°～90°,接近健侧.拇指掌指关节屈曲后可与所有手指对指,近指间关节活动度从0°至100～120°,远指间关节活动度从0°至90°.指端两点分辨觉同健侧,外观和功能满意.结论 采用示指转位治疗重度发育不全的拇指,外形和功能满意,克服了以往采用皮瓣和骨瓣移植的缺点,是一种实用而可取的方法,值得推广.     

半关节移植治疗重复拇指畸形伴指间关节严重发育不良

目的 通过半关节移植修复缺如的指间关节近端关节面及侧副韧带，重建重复拇指畸形患者严重偏斜的指间关节。方法 1994年3月—2002年11月间，对7例患者利用赘生拇指近节指骨的近端关节面及部分关节囊，行一期或二期半关节移植，重建保留拇指的指间关节近端发育不良或缺如的关节面。术后随访3年，观察骨关节生长及功能恢复情况。结果 移植的半关节大部存活，85％患者的骨外形良好、功能恢复较满意。结论 半关节移植是治疗重复拇指畸形伴指间关节严重发育不良的一种可行的手术方法。     

Pollicization of Middle Finger in a Cleft Hand Associated with Acrorenal Syndrome

Introduction  Acrorenal syndrome is autosomal recessive inherited disorder commonly associated with congenital renal disorders and ipsilateral hand/foot anomalies. The hand and foot deformities corrections are challenging to achieve a good functional and cosmetic result. We described a case of acrorenal syndrome with suppressed radial elements and absent thumb in whom we were able to reconstruct the hand. Case Report  A 5-year-old girl presented to us with right renal agenesis and right hand/foot deformity. The hand showed a cleft hand with central deficiency, index finger hypoplastic, and syndactylyzed to middle finger, absent thumb. The hand was nonfunctional because of absent thumb. To improve the functions, it was decided to proceed with thumb reconstruction. The middle finger was pollicized to regain tripod grip and thereby the functions was enhanced. Discussion  The cleft hand belongs to “failure of finger ray induction group” in classification by “International Federation of Societies for Surgery of the Hand (IFSSH).” Absence of thumb and first web space makes it a strong indication for surgical reconstruction. In our case, thumb was addressed by pollicization of middle finger and we were able to provide a good tripod grip.     

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...     

Classification of congenital thumb hypoplasia and deformity

BackgroundCongenital thumb deformities account for one-third or more of all cases of congenital hand deformity. However, the current classification schemes of congenital thumb hypoplasia are no longer adequate due to their lack of adaptability to increasing knowledge in the field. Hence, a modified system with the potential to adapt to ongoing advances in knowledge and understanding is desperately needed.MethodsBased on the photographs collected from thousands of cases of congenital deformities of the hand and upper limb over multiple decades in our department, we subdivided thumb hypoplasia according to the variables of morphological characteristics, anatomical structures, functional status, the relationship between thumb deformity and hand deformity, the relationship between congenital hand deformity syndrome and thumb hypoplasia, and the selection of treatment methods.ResultsA total of 10 types were presented, which were elucidated with nomenclatures as well as pathological feature and symptoms.ConclusionThis modified system may shed additional light on the classification of congenital thumb anomalies, which will assist in a more effective selection of treatment modalities and offers significant benefits to both patients and practice.