CAJ | 학술논문

目的探讨儿童非典型Wassel Ⅵ型复拇畸形的手术治疗方法.方法回顾性分析2008年5月至2012年3月收治的4例非典型WasselⅥ型复拇畸形的临床资料.其中,男2例,女2例;年龄11个月～3.5岁,平均1.8岁;左侧3例,右侧1例.切除桡侧拇指,保留其掌骨,将发育不全的尺侧拇指的掌骨远端嫁接于桡侧拇指掌骨,交叉克氏针固定,大鱼际肌止点缝合于尺侧拇指近节指骨桡背侧,术后拇外展石膏托固定.骨折愈合后拔出克氏针,拇指外展弹性支具固定3个月.结果术中发现4例均存在尺侧拇指掌骨明显发育不良,近端缺如;桡侧拇指发育不良,指间关节尺偏,2例无屈曲功能.大鱼际肌均附着于桡侧拇指近节指骨基底桡侧.术后随访12～46个月,平均26个月.术后骨折愈合慢,于8～12周拔出克氏针.根据Tada等制定的标准评价:4例均为优.结论非典型WasselⅥ型复拇畸形罕见,手术方法与Wassel Ⅵ型截然不同.掌骨嫁接和大鱼际肌止点移位是手术治疗的关键.
목적 탐토인동비전형Wassel Ⅵ형복무기형적수술치료방법.방법 회고성분석2008년5월지2012년3월수치적4례비전형WasselⅥ형복무기형적림상자료.기중,남2례,녀2례;년령11개월～3.5세,평균1.8세;좌측3례,우측1례.절제뇨측무지,보류기장골,장발육불전적척측무지적장골원단가접우뇨측무지장골,교차극씨침고정,대어제기지점봉합우척측무지근절지골뇨배측,술후무외전석고탁고정.골절유합후발출극씨침,무지외전탄성지구고정3개월.결과 술중발현4례균존재척측무지장골명현발육불량,근단결여;뇨측무지발육불량,지간관절척편,2례무굴곡공능.대어제기균부착우뇨측무지근절지골기저뇨측.술후수방12～46개월,평균26개월.술후골절유합만,우8～12주발출극씨침.근거Tada등제정적표준평개:4례균위우.결론 비전형WasselⅥ형복무기형한견,수술방법여Wassel Ⅵ형절연불동.장골가접화대어제기지점이위시수술치료적관건.
Objective To explore an effective treatment for atypical Wassel type Ⅵ thumb duplication.Methods Four pediatric cases of atypical Wassel type Ⅵ thumb duplication were studied retrospectively.There were 2 males and 2 females with an average age of 1.8 (11/12-3.5) years.Three cases were left-sided and one right-sided.During operation,after resection of radial digit,ulnar digit was transported to the top of radial metacarpal bone and fixed with pinning.And end point of thenar was shifted to the base of proximal phalanx.Fixation with plaster was applied and Kirschner wire removed after fracture healing.Brace was used for fixation and thumb abduction maintained for about 3 months.Results The intraoperative findings revealed that ulnar metacarpal-like bone was remarkably hypoplastic.Radial metacarpal-like bone was shorter than normal metacarpal and interphalangeal joint had ulnar deviation.Two patients had a lack of extensor tendon.The end point of thenar was attached to the base of radial proximal phalanx.All patients were followed up for an average of 26 (12-46) months.There was delayed metacarpal union and Kirschner wire was removed at 8-12 weeks.According to the Tada standard,all patients were excellent.Conclusions Atypical Wassel type Ⅵ thumb duplication is rare.And its treatment is completely different from that of Wassel type Ⅵ.Metacarpal bone transportation and end point of thenar shift are key points for the treatment of atypical Wassel type Ⅵ thumb duplication.