CAJ | 학술논문

目的以形态和轴线偏移情况为依据,对发生在末节的复拇畸形进行新的分类,以此对末节复拇畸形进行个体化治疗,并对手术效果进行评估.方法回顾分析2003年4月至2012年12月收治的在指间关节以远分叉的复拇畸形共76例77指.以指体形态(指甲宽度和指体周径)和轴线偏移为指标进行综合分型,共分为5个类型:A型,非骨性连接型(漂浮拇);B型,主次轴线正常型;C型,主次轴线偏移型;D型,对称轴线正常型;E型,对称轴线偏移型.根据分型的不同采用不同的治疗方法:A型,次指单纯切除;B型,次指(绝大多数为桡侧指)切除+指间关节关节囊侧副韧带修复;C型,次指(绝大多数为桡侧指)切除+指间关节关节囊侧副韧带修复+近节指骨颈部截骨;D型,改良Bilhaut-Cloquet术+指间关节关节囊侧副韧带修复;E型,采用传统Bilhaut-Cloquet术,或者改良Bilhaut-Cloquet术+指间关节关节囊侧副韧带修复+近节指骨颈部截骨.手术效果以日本手外科学会多拇疗效评价表测评.结果 77指中A型3指,B型36指,C型13指,D型15指,E型10指.经6个月至5年随访,优66指,良9指,可2指.结论新的分型方法能更全面地体现末节复拇畸形的临床特征,而且每种类型均可以采用可重复的基本术式进行个性化的治疗,效果令人满意.
목적 이형태화축선편이정황위의거,대발생재말절적복무기형진행신적분류,이차대말절복무기형진행개체화치료,병대수술효과진행평고.방법 회고분석2003년4월지2012년12월수치적재지간관절이원분차적복무기형공76례77지.이지체형태(지갑관도화지체주경)화축선편이위지표진행종합분형,공분위5개류형:A형,비골성련접형(표부무);B형,주차축선정상형;C형,주차축선편이형;D형,대칭축선정상형;E형,대칭축선편이형.근거분형적불동채용불동적치료방법:A형,차지단순절제;B형,차지(절대다수위뇨측지)절제+지간관절관절낭측부인대수복;C형,차지(절대다수위뇨측지)절제+지간관절관절낭측부인대수복+근절지골경부절골;D형,개량Bilhaut-Cloquet술+지간관절관절낭측부인대수복;E형,채용전통Bilhaut-Cloquet술,혹자개량Bilhaut-Cloquet술+지간관절관절낭측부인대수복+근절지골경부절골.수술효과이일본수외과학회다무료효평개표측평.결과 77지중A형3지,B형36지,C형13지,D형15지,E형10지.경6개월지5년수방,우66지,량9지,가2지.결론 신적분형방법능경전면지체현말절복무기형적림상특정,이차매충류형균가이채용가중복적기본술식진행개성화적치료,효과령인만의.
Objective To study the classification and individualized treatment of the terminal phalanx of thumb duplication.Methods From Apr.2003 to Dec.2012,76 patients with 77 involved thumbs duplication at the level which is distal to the interphalangeal joint were retrospectively studied.Based on the morphology (the nail width and the thumb circumference) and the deviation of the thumb,we classified the terminal phalanx of thumb duplication into 5 types as Type A (no bony connection called floating thumb),Type B (asymmetry and no deviation),Type C (asymmetry and deviation),Type D (symmetry and no deviation) and Type E (symmetry and deviation).Different surgical procedures were selected according to different types.Simple excision of the smaller thumb was adopted for Type A case.Removement of the smaller thumb (usually the radial) and of the collateral ligament of the interphalangeal joint were selected for Type B.Removement of the smaller thumb (usually the radial) and reconstruction of the collateral ligament of the interphalangeal joint,as well as corrective osteotomies at the neck of the proximal phalanx were performed for Type C.The modified Bilhaut-Cloquet procedure with reconstruction of the collateral ligament of the interphalangeal joint were adopted in Type D.The classical Bilhaut-Cloquet procedure,or the modified Bilhaut-Cloquet procedure with reconstruction of the collateral ligament of the interphalangeal joint and corrective osteotomies at the neck of the proximal phalanx were performed in Type E.The results were assessed by an evaluation form for thumb duplication by the Japanese Society for Surgery of the Hand.Results According to our new classification standard,there were 3 cases with Type A duplicated thumbs,36 with Type B,13 with Type C,15 with Type D,10 with Type E.All the 76 patients underwent the individualized surgical treatment.The patients were followed up for 6-60 months.According to the evaluation form,excellent results were achieved in 66 thumbs,good in 9 thumbs and fair in 2 thumbs.Conclusions The new classification could comprehensively describe the clinical features of the terminal phalanx of congenital thumb duplication.Individualized therapy,including basic and repeated surgical procedure could be adopted for each type with satisfactory results.