Alewijnse Juul V, Smeulders Mark J C, Kreulen Mick
*Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam †Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
J Pediatr Orthop. 2015 Dec;35(8):825-30. doi: 10.1097/BPO.0000000000000380.
Thumb-in-palm deformity disturbs a functional grip of the hand in patients with cerebral palsy. Reported recurrence rates after surgical correction are contradicting and earlier studies are limited to short-term follow-up. Therefore, the aim of this retrospective clinical outcome study is to evaluate the success rate of surgical correction of thumb-in-palm deformity around 1 year and at a minimum of 5 years follow-up. In addition, long-term patient satisfaction of the treatment is evaluated.
Patients with cerebral palsy who underwent a surgical correction for their thumb-in-palm deformity between April 2003 and April 2008 at the Academic Medical Center in Amsterdam were included. All patients were classified into 4 categories according to the assessment system of the Committee on Spastic Hand Evaluation. The result of surgery was considered "short-term successful" and "long-term successful" when, respectively, short-term and long-term classification was better compared with preoperative. The association between the patient satisfaction outcomes and the long-term clinical outcomes were statistically analyzed.
Data were collected from 39 patients and their charts. The success rate was 87% at short-term follow-up, which in the long term decreased to 80%. Interestingly, thumb position deteriorated in 29% of the patients between short-term and long-term follow-up. In the long term, 74% of the patients were satisfied with the position of their thumb and 87% would undergo the surgery again. Both these outcomes were statistically significant associated with the long-term success rate (P<0.05).
The surgical correction of thumb-in-palm deformity has a high clinical success rate and patient satisfaction in the long term. However, it should be taken into account that the clinical result around 1 year postoperative cannot be considered final.
拇指内收畸形会影响脑瘫患者手部的功能性抓握。手术矫正后的复发率报道不一，早期研究仅限于短期随访。因此，这项回顾性临床结果研究的目的是评估拇指内收畸形手术矫正约1年及至少5年随访后的成功率。此外，还评估了患者对治疗的长期满意度。
纳入2003年4月至2008年4月在阿姆斯特丹学术医疗中心因拇指内收畸形接受手术矫正的脑瘫患者。根据痉挛性手部评估委员会的评估系统，将所有患者分为4类。当短期和长期分类分别比术前更好时，手术结果被认为“短期成功”和“长期成功”。对患者满意度结果与长期临床结果之间的关联进行统计学分析。
收集了39例患者及其病历的数据。短期随访时成功率为87%，长期则降至80%。有趣的是，29%的患者在短期和长期随访之间拇指位置恶化。长期来看，74%的患者对拇指位置满意，87%的患者愿意再次接受手术。这两个结果均与长期成功率有统计学显著关联（P<0.05）。
拇指内收畸形的手术矫正长期具有较高的临床成功率和患者满意度。然而，应考虑到术后约1年的临床结果不能被视为最终结果。
