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[儿童手部先天性第一指缺如的示指拇化术]

[Index finger pollicization for congenitally deficient first finger of the hand in children].

作者信息

Vázquez Rueda F, Ayala Montoro J, Blanco López F, Ocaña Losa J M

机构信息

Servicio de Cirugía Pediátrica, Unidad de Traumatología y Ortopedia Infantil, Hospital Universitario Reina Sofía Córdoba.

出版信息

Cir Pediatr. 2001 Oct;14(4):156-61.

Abstract

Pollicization is a single-stage neurovascular pedicle transfer of the index digit to function as a thumb. The objective of this study is to investigate the results of index finger pollicization for correction of congenital deficiency of the first ray in pediatric hand. We have done 6 pollicizations of index fingers in 6 hands (there were 2 right hands, 2 left hands, and 1 bilaterally) in 5 patients (4 boys and 1 girl) who had absent or nonfunctioning thumbs (type III-V of Blauth's classification). Associated anomalies where numerous and included radial club hand, mirror hand and cardiovascular and urologic anomalies. The average time of Kirschner wire extraction was 32 days (30 to 36 days) and to beginning the hand rehabilitation at 5 degrees to 10 degrees day. The average age at pollicization was 5.5 years (range 2 to 8 years), and follow-up averaged 8 years (5 to 11 years). The cosmetic and functional results were excellent, with manual dexterity of prehension and opposition. Pollicization in children can be performed at least 2 years of age, to due of minor risk of neurovascular lesion but without delayed the cortical representation of the pollicized finger.

摘要

拇指化手术是将示指通过单阶段带血管神经蒂转移来发挥拇指功能。本研究的目的是探讨小儿手部先天性第一掌骨发育不全矫正中示指拇指化手术的效果。我们对5例(4例男孩和1例女孩)拇指缺如或无功能(Blauth分类Ⅲ - V型)的患者的6只手进行了6次示指拇指化手术(其中2只为右手,2只为左手,1例为双侧)。合并的畸形众多,包括桡侧多指畸形、镜手畸形以及心血管和泌尿系统畸形。克氏针拔除的平均时间为32天(30至36天),并在术后第5天至第10天开始手部康复训练。拇指化手术的平均年龄为5.5岁(范围2至8岁),随访平均8年(5至11年)。美容和功能效果极佳,具备抓握和对掌的手部灵活性。儿童拇指化手术至少可在2岁时进行,因为神经血管损伤风险较小,且不会延迟拇指化手指的皮质代表区形成。

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