Shen Kaiying, Wang Zhigang, Xu Yunlan
Department of Pediatric Orthopedics, Shanghai Children's Medical Center, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
Plast Reconstr Surg Glob Open. 2017 Feb 1;5(2):e1216. doi: 10.1097/GOX.0000000000001216. eCollection 2017 Feb.
The purpose of this study was to present a novel surgical technique using an on-top osteotomy and to assess the clinical and radiographic outcomes for the triphalangeal Wassel type VI thumb duplication patients.
The surgical technique involves ablation of the radial thumb at distal one-third of the metacarpal, corresponding metacarpal osteotomy of the ulnar thumb, with amalgamation of 2 metacarpals and reconstruction of the ulnar thumb by a series of soft tissue procedures. Clinical and radiologic outcomes were evaluated by using the Japanese Society for Surgery of the Hand evaluation form at a minimum of 30 months. The size of the metacarpal was measured and compared to the opposite one to assess the growth of the thumb.
Five patients, including 4 males and 1 female, were observed for an average of 37 months. All amalgamated metacarpal showed bone union in 6 weeks after surgery and revealed growth with the age. The average length of the metacarpal was 86% of the opposite one at the final follow-up. Motion at the metacarpophalangeal and interphalangeal joints showed no restriction after surgery, and they reached excellent function for gripping and pinching. According to the JHHS scoring system, the results were excellent in 3 cases, good in 2.
This novel surgical technique for the reconstruction of Wassel type VI radial polydactyly with triphalangeal shows encouraging results in both clinical and radiologic evaluations; meanwhile long-term results are under evaluation.
本研究的目的是介绍一种使用顶置截骨术的新型手术技术，并评估三指型瓦塞尔VI型拇指重复畸形患者的临床和影像学结果。
手术技术包括在掌骨远端三分之一处切除桡侧拇指，对尺侧拇指进行相应的掌骨截骨，将两根掌骨融合，并通过一系列软组织手术重建尺侧拇指。使用日本手部外科学会评估表至少在30个月时评估临床和放射学结果。测量掌骨大小并与对侧进行比较，以评估拇指的生长情况。
观察了5例患者，包括4例男性和1例女性，平均观察时间为37个月。所有融合的掌骨在术后6周均显示骨愈合，并随年龄增长而生长。末次随访时，掌骨平均长度为对侧的86%。掌指关节和指间关节术后活动无受限，抓握和捏取功能达到优良。根据JHHS评分系统，3例结果为优，2例为良。
这种用于重建三指型瓦塞尔VI型桡侧多指畸形的新型手术技术在临床和影像学评估中均显示出令人鼓舞的结果；同时长期结果正在评估中。
