Pediatric Orthopaedics Unit, Children Hospital, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
Orthop Traumatol Surg Res. 2010 Sep;96(5):521-4. doi: 10.1016/j.otsr.2010.01.013. Epub 2010 Jul 1.
In the Wassel type IV classification category, the thumb is duplicated from the metacarpophalangeal joint; this abnormality accounts for approximately 50% of the cases of thumb duplication. Type IV is divided into four subtypes in which the IV-D type, or convergent (9% of cases), is the most complex form because both thumbs are hypoplastic with a divergent metacarpophalangeal joint and a convergent interphalangeal joint. Reconstruction is prone to axis deformity and ligament laxity, whereas the Bilhaut-Cloquet technique's main pitfall is nail dystrophy. We propose a modified Bilhaut-Cloquet procedure to avoid these complications.
Four males (mean age: 11 months; range: 10-12 months) with IV-D thumb duplication were operated on using a modified Bilhaut-Cloquet procedure.
The skin is preliminarily marked, taking into account the excision of the central skin and the more hypoplastic nail of the two (most often the radial nail). Both proximal phalanges are split longitudinally and the central halves discarded. An oblique osteotomy is performed at the base of the distal phalanx of the ulnar thumb duplicate (the less hypoplastic) and the radial wedge is excised. The same osteotomy is applied to the distal phalanx of the radial thumb duplicate, but the radial wedge is preserved. The proximal phalanx and the bases of the distal phalanx are joined by bone suture. Axis correction and ligament stability are thus achieved without nail surgery.
The patients were examined with a mean 24 months of follow-up (range: 12-36 months). The result was good in all four cases according to the Horii score.
This procedure combines an excision of the central part of the proximal phalanx and partial excision of the base of the distal phalanx. It provides axis correction and stabilization of the interphalangeal joint while avoiding subsequent nail dystrophy because a single nail is preserved. Preliminary results are encouraging: no axis deformity, instability or nail dystrophy has been noted. Nonetheless, the long-term results need to be evaluated.
IV retrospective study.
在 Wassel Ⅳ型分类中，拇指从掌指关节处重复；这种异常约占拇指重复的 50%。Ⅳ型分为四个亚型，其中Ⅳ-D 型，即会聚型（占 9%）是最复杂的形式，因为两个拇指都发育不良，掌指关节发散，指间关节会聚。重建容易导致轴畸形和韧带松弛，而 Bilhaut-Cloquet 技术的主要缺点是指甲发育不良。我们提出了一种改良的 Bilhaut-Cloquet 手术来避免这些并发症。
4 名男性（平均年龄：11 个月；范围：10-12 个月）采用改良的 Bilhaut-Cloquet 手术治疗Ⅳ-D 型拇指重复。
初步标记皮肤，考虑到切除中央皮肤和两个拇指中更发育不良的指甲（通常是桡侧指甲）。两个近节指骨均纵向劈开，中央半部分切除。在尺侧拇指重复的远节指骨基底行斜形骨切开术，并切除桡侧楔形骨块。对桡侧拇指重复的远节指骨行同样的骨切开术，但保留桡侧楔形骨块。用骨缝线将近节指骨和远节指骨基底连接起来，从而实现轴矫正和韧带稳定，而无需进行指甲手术。
4 例患者平均随访 24 个月（范围：12-36 个月）。根据 Horii 评分，所有 4 例均为良好结果。
该手术结合了近节指骨中央部分的切除和远节指骨基底的部分切除。它提供了轴矫正和指间关节的稳定，同时避免了随后的指甲发育不良，因为保留了单个指甲。初步结果令人鼓舞：未发现轴畸形、不稳定或指甲发育不良。然而，仍需要评估长期结果。
IV 回顾性研究。
Zotero 插件