Nan Guo-Xin, Su Yu-Xi, Cai Wen-Quan, Qin Jia-Qiang, Wang Zhong-Liang, He Bo, Zhang De-Wen
Orthopedic Department II, Children' s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing 400014, China.
Zhonghua Zheng Xing Wai Ke Za Zhi. 2013 Jan;29(1):18-21.
To investigate an effective therapeutic method for the secondary deformity after the correction of the Wassel type IV thumb duplication.
9 cases of Wassel W-D Complex thumb deformities in children with postoperative secondary deformity, including 6 males and 3 female, were treated. The age ranged from 2.0 to 14 years old with an average of 5.3 years old. During the operation, the anatomical structure was dissected to observe the structure and alignment of the flexor tendon as well as anatomical structure of the joint. In the meantime, the flexor pollicis longus tendon was shifted, A2 pulley was reconstructed, joint capsule was released and contracted, the end point of thenar was shifted. Kirschner wires fixation were used for about 4-5 weeks, the brace fixation for about 3 months.
All the patients had radial side skin contracture of the interphalangeal joint, radial deviation of the thumb tip, radial side contracture and ulnar relaxation of the joint capsule. Flexor hallucis longus tendon was located in front of the radial side of the proximal phalanx, with no wrapped sheath or A2 pulley. Flexor hallucis longus tendon was attached to the thumb tip substrate, of which 1/3 was located in the center and 2/3 in the radial side. The thumb tip rotated about 10 degrees-15 degrees to the radial side. The patients were followed up for 6-38 months, with an average of 24 months. We adopted Tada standard to evaluate the follow-up results as excellent in 7 cases, good in 1 case, poor in 1 case.
Soft tissue reconstruction for the secondary deformity after the correction of the Wassel type IV-D thumb duplication is an effective method. Application of the brace after removal of Kirschner wires has an important role in preventing the secondary deformity.
探讨瓦塞尔IV型拇指重复畸形矫正术后继发畸形的有效治疗方法。
对9例瓦塞尔W-D复合拇指畸形患儿术后继发畸形进行治疗，其中男6例，女3例。年龄2.0～14岁，平均5.3岁。手术中解剖结构，观察屈肌腱的结构和走行以及关节的解剖结构。同时，移位拇长屈肌腱，重建A2滑车，松解并紧缩关节囊，移位鱼际肌止点。克氏针固定约4～5周，支具固定约3个月。
所有患者均有指间关节桡侧皮肤挛缩、拇指指尖桡偏、关节囊桡侧挛缩及尺侧松弛。拇长屈肌腱位于近节指骨桡侧前方，无腱鞘或A2滑车包裹。拇长屈肌腱附着于拇指指尖基底，其中1/3位于中央，2/3位于桡侧。拇指指尖向桡侧旋转约10°～15°。对患者进行6～38个月随访，平均24个月。采用多田标准评估随访结果，优7例，良1例，差1例。
瓦塞尔IV-D型拇指重复畸形矫正术后继发畸形的软组织重建是一种有效的方法。克氏针拔除后应用支具对预防继发畸形有重要作用。
