手术时机对儿童先天性拇指多指畸形手术的效果体会

目的　分析不同手术时机对儿童先天性拇指多指畸形手术的效果。方法　选取2017年5月至2021年5月期间在河池市第一人民医院接受先天性拇指多指畸形手术的患儿50例，其中男26例，女24例，年龄（1.6±0.4）岁。所有患儿均在术前接受影像学检查及常规检查，分为WasselⅠ型、WasselⅡ型、WasselⅢ型、WasselⅣ型、WasselⅤ型、WasselⅥ型、WasselⅦ型，分别在1.5岁、1.0岁、2.5岁左右进行单纯多指切除术、关节囊修复术、皮瓣成形术、截骨矫形、肌腱移位、移植、韧带重建，术后1年、2年对患儿手术情况进行随访，通过改良Tada评分法评估患儿治疗效果。结果　50例患儿中31例治疗效果为优，12例为良，5例为中，2例为差，优良率为86.00%。1年后对患儿手术情况进行随访，1例患儿患指出现成角畸形，1例患儿出现患指掌功能障碍，2年后对患儿手术情况进行随访，1例出现患指掌指关节残留骨骺，再次对以上患儿进行手术后，患儿拇指外观、伸屈功能恢复良好，位置满意度高，对日常生活完全无影响。结论　先天性拇指多指畸形手术需根据患儿拇指骨化中心出现时间、畸形结构、严重程度合理判断手术时机，结合不同患儿情况，制定个性化治疗方案，提高手术操作精细度，加强术后随访，方能更好确保手术效果。

Effect of operation timing on children with congenital thumb polydactyly

Objective　To analyze the effect of different operation timings on children with congenital thumb polydactyly. Methods　A total of 50 children with congenital thumb polydactyly were selected in The First People's Hospital of Hechi City from May 2017 to May 2021, including 26 males and 24 females, aged (1.6±0.4) years. All the children received imaging examinations and routine examinations before operation. They were divided into Wassel Ⅰ type, Wassel Ⅱ type, Wassel Ⅲ type, Wassel Ⅳ type, Wassel Ⅴ type, Wassel Ⅵ type, and Wassel Ⅶ type, and received simple polydactyly resection, joint capsule repair, flap plasty, osteotomy, tendon displacement, transplantation, and ligament reconstruction at about 1.5 years old, 1.0 year old, and 2.5 years old. All the children were followed up 1 year and 2 years after operation, and the treatment effect was evaluated by the modified Tada score. Results　Among the 50 cases, the therapeutic effect was excellent in 31 cases, 12 good cases, 5 moderate cases, 2 poor cases, and the excellent and good rate was 86.00%. The children were followed up 1 year later, and 1 child had angular deformity of the affected finger, and 1 child had the palmar dysfunction of the affected finger. The children were followed up 2 years later, 1 child had the metacarpophalangeal joint residual epiphysis of the affected finger. After re-operation on the above children, the appearance and extension and flexion function of the thumb in the children recovered well, and the position satisfaction was high, no impact on daily life at all. Conclusions　The operation timing of congenital thumb polydactyly should be based on the appearance time of the thumb ossification center, the deformity structure, and the severity. The operation timing should be reasonably judged, the individualized treatment plan should be formulated according to the different children's conditions, the precision of the operation should be improved, and the postoperative follow-up should be strengthened, so as to better ensure the surgical results.