复合组织移位组合重建术在复杂性多拇畸形治疗中的应用

目的评价复合组织移位组合重建术在复杂性多拇畸形治疗中的疗效。方法2001年9月至2019年2月北京积水潭医院手外科收治多拇畸形64例,平均年龄2.7(1~20)岁,均为桡侧指近端发育可,远端发育不良,而尺侧指远端外形美观,近端发育不良的病例。WasselⅣ型6例、WasselⅤ型1例、WasselⅥ型典型者9例,非典型者35例,WasselⅦ型10例,不符合Wassel分型者3例。采用将尺侧指向桡侧复合组织移位组合重建的方法治疗。术后采用Tada评分、测量虎口、调查患者满意度等方式评估拇指外形及功能。结果患者行尺侧指直接移位者17例,行尺侧指移位+M形皮瓣开大虎口者43例,采用尺侧指甲瓣套接者1例,分期行复合组织移位组合重建术者3例。平均随访时间3.9(1~9)年。患者非常满意44例,满意9例,一般10例,不满意1例。Tada评分优者55例,良9例。术后双手虎口大小差异无统计学意义(P>0.05)。结论在多拇畸形中,针对桡、尺侧指远、近端非对称性发育不良者,采用复合组织移位组合重建的手术方法是一种有效的治疗手段。

Composite tissue transposition of asymmetric thumb for radial polydactyly reconstruction

Objective To evaluated the outcome of composite tissue transposition for radial polydactyly reconstruction using the"on-top plasty"technique.Methods Sixty-four cases of radial polydactyly were enrolled retrospectively in Department of Hand Surgery,Beijing Jishuitan Hospital from September 2001 to February 2019.The average age of the patients was 2.7 years(range,1-20 years)and at final follow-up was 3.9 years(rang,1-9 years).One of the thumbs was not obviously dominant over the other,with radial thumb having a better proximal portion and the ulnar one having a better distal portion.There were 6 cases of Wassel IV,1 case of Wassel V,9 cases of typical WasselⅥ,35 cases of atypical and 10 cases of WasselⅦ,3 cases were not included in Wassel type.All of them underwent"on-top plasty"technique.The shape and function of the thumb were evaluated by Tada score,measurement of the thumb web space and satisfaction of the patients.Results Seventeen cases underwent direct transposition of ulnar finger without thumb web enlarged,43 cases were with M-shaped flap,and 1 case was treated with transplantation of ulnar thumb nail flap,3 cases underwent a 2-stage"on-top plasty"technique.Very satisfied were observed in 44 cases,satisfied in 9 cases,fair in 10 cases,poor 1 in cases.According to Tada score,55 cases were good and 9 cases were fair.There was no significant difference in thumb web space of healthy and affected side(P>0.05).Conclusion"On-top plasty"is a reliable procedure that has good outcome and should be considered in the rare cases of radial polydactyly when neither thumb possesses sufficient proximal and distal structures for acceptable function and appearance.