Xu Yun-lan, Shen Kai-Ying, Chen Ji, Wang Zhi-gang
Department of Pediatric Orthopedics, Shanghai Children's Medical Center, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pediatric Orthopedics, Shanghai Children's Medical Center, affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Hand Surg Am. 2014 Jan;39(1):75-82.e1. doi: 10.1016/j.jhsa.2013.10.003.
To report a modified reconstructive technique for Wassel type IV-D thumb duplication that preserves and transfers the flexor pollicis longus (FPL) from the removed radial portion.
We analyzed the hands of 16 patients (average age, 2 y) with Wassel IV-D thumb duplication. Patients were treated with ablation of the radial thumb and reconstruction of the ulnar thumb by a series of soft tissue procedures, including FPL rebalancing. The postoperative range of motion and the alignment at the metacarpophalangeal and interphalangeal joints of the affected thumbs were compared with the preoperative measurements.
Of 16 cases, 14 were observed for an average of 29 months. Motion at the interphalangeal joint and alignment at metacarpophalangeal and interphalangeal joints showed improvement after surgery. According to the Japanese Society for Surgery of the Hand scoring system, the results were excellent in 2 cases, good in 11, and fair in 1. A disadvantage of this technique proved to be restricted interphalangeal joint motion with an extension lag that averaged 14°.
The FPL rebalancing technique with soft tissue stabilization of the metacarpophalangeal and interphalangeal joints can establish dynamic rebalance of the bifurcated FPL tendon in Wassel IV-D duplicated thumb. It shows excellent results in alignment and joint stability. The long-term results are under evaluation.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
报告一种改良的重建技术，用于治疗瓦塞尔IV - D型拇指重复畸形，该技术保留并转移切除的桡侧部分的拇长屈肌（FPL）。
我们分析了16例（平均年龄2岁）患有瓦塞尔IV - D型拇指重复畸形患者的手部情况。通过一系列软组织手术，包括FPL重新平衡，对患者进行桡侧拇指切除及尺侧拇指重建治疗。将患侧拇指掌指关节和指间关节术后的活动范围及对线情况与术前测量结果进行比较。
16例患者中，14例得到平均29个月的观察。术后指间关节活动度以及掌指关节和指间关节的对线情况均有改善。根据日本手部外科学会评分系统，结果为优2例，良11例，可1例。该技术的一个缺点是指间关节活动受限，平均伸直延迟14°。
FPL重新平衡技术结合掌指关节和指间关节的软组织稳定，可在瓦塞尔IV - D型重复拇指中实现分叉的FPL肌腱的动态重新平衡。在对线和关节稳定性方面显示出优异的结果。长期结果正在评估中。
研究类型/证据水平：治疗性IV级。
