采用掌骨部分移位重建改良Blauth 3B及3C型发育不良拇指的疗效观察

目的 观察第2掌骨纵向半侧骨干移位和二期拇对掌功能重建治疗改良Blauth 3B和3C型拇指发育不良的疗效.方法 2013年12月至2018年6月,复旦大学附属华山医院手外科收治的改良Blauth3B和3C型患儿资料12例.将第2掌骨纵向半侧移位延长第1掌骨,稳定第一腕掌关节.确认骨折愈合后,二期行肌腱移位拇对掌功能重...

Hemi-longitudinal metacarpal transfer for modified Blauth 3B and 3C hypolastic thumbs reconstruction

Objective To assess the outcomes of the treatment of reconstruct for modified Blauth 3B and 3C hypoplastic thumbs by hemi-longitudinal second metacarpal and opposition tendon transfer.Methods From December 2013 to June 2018,12 children with modified Blauth 3B or 3C hypoplastic thumbs were treated in Department of Hand Surgery,Huashan Hospital,Fudan Vniversity.The treatment included two phases.In the first phase,the short metacarpal was lengthened and the unstable first carpometacarpal joint was reconstructed by hemi-longitudinal second metacarpal transfer.The second phase of the treatment was conducted 3 months after confirming the union of the bone.Union of the metacarpal,complications were observed.Their pinch,opposition,grasp,mobility,sensibility and cosmetic appearance were measured.Percival's assessment of pollicization was used.The function of pinch,opposition,grasp,mobility,sensibility,cosmetic appearance were assessed to each thumb.Result The outcomes were measured after 3.4 years in average.Nine children reached the union of the first metacarpal.Nonunion of the first metacarpal occurred in 2 patients and fracture of the second metacarpal occurred in 1 patient.The nonunion and fracture were cured in the second phase of the treatment.Six patients reached excellent grades;three reached good grades and three got fair grades.Conclusion The hemi-longitudinal second metacarpal transfer with second stage tendon transfer is an effective procedure to reconstruct a functional thumb in patients with modified Blauth 3B and 3C hypoplastic thumbs.Using this method,the thumb was preserved with relatively good function.Long-term outcomes need further follow-up.