Aleem Alexander W, Wall Lindley B, Manske M Claire, Calhoun Valerie, Goldfarb Charles A
Department of Orthopaedic Surgery, Shriner's Hospital for Children and St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO.
Department of Orthopaedic Surgery, Shriner's Hospital for Children and St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO.
J Hand Surg Am. 2014 Feb;39(2):226-36. doi: 10.1016/j.jhsa.2013.11.002. Epub 2013 Dec 18.
To evaluate the implications of the transverse bone in cleft hand by assessing outcomes after reconstruction in comparison with a control group.
This study is a retrospective review of 23 hands in 18 patients following surgical reconstruction of the cleft hand. Eleven hands had a transverse bone component, and 12 hands (control group) did not. Patients and their families were contacted to assess overall satisfaction following reconstruction. Clinical and radiographic records were reviewed to assess aesthetic and functional outcomes, the need for additional surgery, and radiographic divergence angles.
There was no difference in aesthetic or functional subjective outcomes. There was no statistically significant difference in any objective outcome measure between the two groups. The use of the cleft for pinch was more dependent on the status of the index finger and the preoperative thumb-index webspace rather than the presence of a transverse bone. Eleven (4 transverse and 7 control) hands required additional surgery to address abnormal function or posture of the index and ring fingers. Preoperative radiographic divergence angles were larger in the transverse bone group than in the control group, whereas postoperative divergence angles were nearly equivalent.
Similar outcomes between the two groups demonstrate that the presence of a transverse bone in cleft hand was not associated with worse outcomes following cleft reconstruction. Preoperative narrowing of the thumb webspace and postoperative index finger metacarpophalangeal joint abnormality are associated with worse functional outcomes.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic Level III.
通过评估与对照组相比重建术后的结果，来评价裂手横骨的影响。
本研究是一项对18例患者的23只手进行裂手手术重建后的回顾性研究。11只手有横骨成分，12只手（对照组）没有。联系患者及其家属以评估重建后的总体满意度。回顾临床和影像学记录以评估美学和功能结果、是否需要额外手术以及影像学发散角。
美学或功能主观结果无差异。两组之间在任何客观结果指标上均无统计学显著差异。利用裂隙进行捏取更依赖于示指的状态和术前拇指-示指蹼间隙，而非横骨的存在。11只手（4只横骨组和7只对照组）需要额外手术来解决示指和环指的异常功能或姿势。术前影像学发散角在横骨组大于对照组，而术后发散角几乎相等。
两组之间相似的结果表明，裂手中横骨的存在与裂手重建术后较差的结果无关。术前拇指蹼间隙变窄和术后示指掌指关节异常与较差的功能结果相关。
研究类型/证据水平：治疗性III级。
