CAJ | 학술논문

目的探讨以拇长屈肌转移平衡术为核心的软组织重建技术在WasselⅣ-D型复拇畸形治疗中的应用和初步疗效.方法 2009年7月至2012年12月收治20例WasselⅣ-D型复拇畸形,平均年龄1.8岁,对尺侧拇指实施一系列软组织重建术.在处理韧带关节囊骨膜瓣、重建拇短展肌及拇短屈肌止点、合并软组织改善拇指体积的基础上,以两个“偏心性”拇长屈肌止点之间的动态平衡来纠正拇指力线,是该术式的指导思想.关键步骤为保留桡侧拇指拇长屈肌腱,将其止点转移至尺侧拇指远节指骨的尺掌侧基底部.结果术后均获得随访,平均时间为28个月,其中17例纳入统计分析.结果显示:重建拇指关节稳定,力线明显改善,功能良好,大小与对侧接近.JHHS评分结果:优3例,良12例,可2例.不足之处是指间关节平均14.的主动背伸受限和指甲发育不良.结论以拇长屈肌转移平衡术为核心的软组织重建术简单有效,重建拇指外观和功能良好,关节稳定,远期疗效值得期待.
목적 탐토이무장굴기전이평형술위핵심적연조직중건기술재WasselⅣ-D형복무기형치료중적응용화초보료효.방법 2009년7월지2012년12월수치20례WasselⅣ-D형복무기형,평균년령1.8세,대척측무지실시일계렬연조직중건술.재처리인대관절낭골막판、중건무단전기급무단굴기지점、합병연조직개선무지체적적기출상,이량개“편심성”무장굴기지점지간적동태평형래규정무지력선,시해술식적지도사상.관건보취위보류뇨측무지무장굴기건,장기지점전이지척측무지원절지골적척장측기저부.결과 술후균획득수방,평균시간위28개월,기중17례납입통계분석.결과현시:중건무지관절은정,력선명현개선,공능량호,대소여대측접근.JHHS평분결과:우3례,량12례,가2례.불족지처시지간관절평균14.적주동배신수한화지갑발육불량.결론 이무장굴기전이평형술위핵심적연조직중건술간단유효,중건무지외관화공능량호,관절은정,원기료효치득기대.
Objective To present the surgical techniques of transferring and rebalancing the flexor pollicis longus (FPL) in soft tissue reconstruction of Wassel type Ⅳ-D radial polydactyly,and to evaluate the preliminary results.Methods From July 2009 to December 2012 a total of 20 cases of Wassel Type Ⅳ-D radial polydactyly were treated.Patients' average age at treatment was 1.8 years.A series of soft tissue reconstruction was conducted at the ulnar duplicate thumb.In addition to joint capsule and collateral ligament manipulation to reconstruct insertions of abductor pollicis brevis and flexor pollicis brevis,and soft tissue merging to increase thumb volume,alignment of the thumb was corrected by FPL transfer to achieve dynamic balance between the two flexor tendon insertions.The key steps included preserving the FPL while removing the radial duplicate thumb and rerouting the radial thumb's FPL tendon insertion onto the ulnovolar side of the distal phalangeal base of the ulnar duplicate thumb.Results All the cases were follow-up for an average of 28 months.Results of 17 cases were used for statistic analysis.The preliminary results showed remarkable improvement of alignment of the reconstructed thumb with stable joints and good function.The size of the reconstructed thumb was comparable to that of the contralateral side.According to JHHS scoring system,the results were rated as excellent in 3 cases,good in 12 cases and fair in 2 cases.The disadvantage of this technique was restricted IP joint motion with an average of 14° extension lag and subsequent nail dystrophy.Conclusion The soft tissue reconstruction of the ulnar duplicate thumb centered on FPL transfer and rebalancing is an effective and convenient technique in treating Wassel type Ⅳ-D radial polydactyly.It provides alignment correction and stabilization of the MCP and IP joints.The cosmetic and functional results are good.The long-term results are to be expected.