Patel A U C, Tonkin M A, Smith B J, Alshehri A H, Lawson R D
Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, Australia.
Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, Australia
J Hand Surg Eur Vol. 2014 Nov;39(9):934-43. doi: 10.1177/1753193413514650. Epub 2013 Dec 5.
The aim of this study is to review the outcomes of Wassel type IV thumb duplications with a minimum of one year follow-up, and to identify any factors that may compromise the quality of results. Forty one patients (42 thumbs) returned for assessment of thumb alignment, metacarpophalangeal joint and interphalangeal joint stability and motion; carpometacarpal joint motion; pinch and grip strengths; and thumb size. The subjective assessment considered thumb shape and contour, scarring, nail deformity and examiner and patient/parent satisfaction. The mean age at surgery was 16 months and the mean follow-up time was 79 months. Metacarpophalangeal joint and interphalangeal joint mal-alignment was present in 56% and 38% of cases, respectively. Interphalangeal ulnar collateral ligament laxity was significant. Metacarpophalangeal joint and interphalangeal joint motion was significantly decreased. Pinch and grip strength measurements were normal. A novel and comprehensive assessment scale is introduced, which revealed results of one (2.5%) excellent, 23 (59%) good, 14 (36%) fair and one (2.5%) poor. We consider that greater attention should be directed to the avoidance of mal-alignment and instability to improve these results.
本研究的目的是回顾至少随访一年的瓦塞尔IV型拇指重复畸形的治疗结果，并确定可能影响结果质量的任何因素。41例患者（42个拇指）接受了拇指对线、掌指关节和指间关节稳定性及活动度、腕掌关节活动度、捏力和握力以及拇指大小的评估。主观评估考虑了拇指形状和轮廓、瘢痕形成、指甲畸形以及检查者和患者/家长的满意度。手术时的平均年龄为16个月，平均随访时间为79个月。分别有56%和38%的病例存在掌指关节和指间关节排列不齐。指间关节尺侧副韧带松弛明显。掌指关节和指间关节活动度明显降低。捏力和握力测量结果正常。引入了一种新颖且全面的评估量表，结果显示1例（2.5%）为优，23例（59%）为良，14例（36%）为中，1例（2.5%）为差。我们认为应更加注重避免排列不齐和不稳定，以改善这些结果。
