目的探讨一期掌骨截骨、拇对掌功能重建结合多边形皮瓣治疗先天性铲状手畸形的临床疗效。方法自2013年1月至2017年3月我们共收治铲状手畸形患儿8例,手术均采用掌骨截骨、拇指对掌功能重建并通过掌背矩形皮瓣重建虎口、多边形皮瓣旋转重建拇指指蹼及拇示指甲侧襞,拇指尺背侧及示指桡侧近节通过植皮修复。结果所有患儿对掌功能与虎口重建均一期完成,植皮完全成活。术后随访时间为13~29个月,平均16.1个月,末次随访时所有患者虎口区皮肤颜色与健侧无明显区别,患手虎口距离为3.5~5.0 cm,平均4.2 cm。术后拇指功能根据改良Tada评分评定:优7例,良1例。结论一期拇对掌功能重建结合多边形皮瓣治疗先天性铲状手畸形术后手部功能改善良好,皮瓣设计合理,能有效覆盖重要区域,手术安全可靠适合临床推广。
Objective To explore the clinical efficacy of one-stage metacarpal osteotomy, thumb opponensplasty and polygonal flap in congenital spade hand reconstruction. Methods From January 2013 to March 2017, 8 cases of congenital spade hand were treated by metacarpal osteotomy, thumb opponensplasty and reconstruction of first web space by dorsal rectangle flap. The thumb web space and fingernail fold of thumb and index finger were reconstructed by rotation of polygonal flap. The dorsoulnar side of thumb and radial side of proximal segment of index finger were repaired by skin grafting. Results The thumb opposition and first web space of all the children achieved one-stage reconstruction. All the flaps and skin grafts survived. The average follow-up period was 16.1 months (range, 13 to 29 months). At the last follow-up, there was no significant difference in skin color between the first web space of the injured side and of the healthy side. The distance of the first web space ranged from 3.5 to 5.0 cm with an average of 4.2 cm. According to the modified Tada score, the results were rated as excellent in 7 cases and good in 1 case. Conclusion One-stage reconstruction of thumb opposition combined with polygonal skin flap for congenital spade hand deformity has improved hand function. The design of the flap is reasonable and can cover important areas effectively. The operation is safe and reliable for clinical application.
Chinses Journal of Hand Surgery