Tien Yin-Chun, Chih Tsai-Tung, Wang Tai-Lung, Fu Yin-Chih, Chen Jian-Chih
Department of Orthopedics, Kaohsiung Medical University, Fooyin University, Kaohsiung, Taiwan.
J Pediatr Orthop. 2007 Jun;27(4):462-6. doi: 10.1097/01.bpb.0000271315.80374.68.
Type IV-D duplicated thumb has the most complex anomalies and difficulties for treatment among polydatyly. Double osteotomy is usually recommended to gain the best cosmetic and functional outcome. However, 4 cases of type IV-D duplicated thumb were treated only by soft tissue procedure in this study. At operation, a conjoined A2 pulley was routinely identified, and the flexor pollicis longus (FPL) was found bifurcated distal to the conjoined pulley in every of these cases. Instead of double osteotomy, a soft tissue procedure that included centralization of FPL and A2 pulley reconstruction was pursued to correct these special anomalies. The overall clinical results were evaluated by a modification of the Tada scoring system based on the range of motion, joint stability, alignment of the remaining thumb, and subjective opinion regarding the reconstructed thumb after an average follow-up of 3.3 years (range, 2.5-4.7 years). According to the scoring system, the results were rated as good in 3 cases and fair in 1 case. From the results, the A2 pulley reconstruction and FPL centralization could prove to be an effective method for the treatment of type IV-D duplicated thumb and could efficiently avoid the residual angular deformities. Therefore, we recommend this soft tissue procedure as an alternative surgical technique to the double-osteotomy procedure for treating a type IV-D duplicated thumb in a very young child, whose bone is still not mature enough for holding the fixing pins.
IV-D型重复拇指在多指畸形中具有最复杂的异常情况和治疗难点。通常建议采用双截骨术以获得最佳的外观和功能效果。然而，在本研究中，有4例IV-D型重复拇指仅采用了软组织手术进行治疗。手术时，常规会发现一个联合的A2滑车，并且在每例此类病例中，拇长屈肌（FPL）在联合滑车远侧呈分叉状。我们采用了一种软组织手术，包括FPL中心化和A2滑车重建，而非双截骨术，来纠正这些特殊异常。在平均随访3.3年（范围为2.5 - 4.7年）后，基于活动范围、关节稳定性、剩余拇指的对线情况以及对重建拇指的主观评价，通过改良的多田评分系统对总体临床结果进行评估。根据该评分系统，结果为3例良好，1例一般。从结果来看，A2滑车重建和FPL中心化可证明是治疗IV-D型重复拇指的有效方法，并且能够有效避免残留的角畸形。因此，对于骨骼仍未成熟到足以固定克氏针的幼儿，我们推荐这种软组织手术作为治疗IV-D型重复拇指的双截骨术的替代手术技术。
