Takagi Takehiko, Seki Atsuhito, Takayama Shinichiro, Watanabe Masahiko
Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
Department of Orthopaedic Surgery, National Center for Child Health and Development, Setagaya, Tokyo, Japan.
Open Orthop J. 2017 Apr 28;11:369-377. doi: 10.2174/1874325001711010369. eCollection 2017.
Radial club hand is a complex congenital abnormality of the radial or pre-axial border of the upper extremity. It has a wide range of phenotypes from hypoplasia of the thumb to complete absence of the radius and the first ray. Centralization with tendon transfer is a popular method for maintaining the correct position of radial club hand. On the other hand, various corrections were devised, . radialization after distraction to emphasize the fact that the head of the ulna is positioned under the radial carpal bones and is no longer placed in a slot in the center of the carpus, microvascular epiphysis transfer, gradual correction using Ilizarov method, for Bayne Type III or Type IV. We should pay attention to the recurrence of radial deformity or circulatory impairment with the tension. Lunate excision or ulnar shortening can be selected for tension-free correction. Radialization can be indicated for avoiding the recurrence of radial flexion. However, we should pay attention of the radial protrusion of the ulnar head. For avoiding the recurrence of radial deformity or circulatory impairment, gradual correction using Ilizarov external fixation can be indicated, especially in the cases with severe radial deviation or with short forearm. In the mild cases, Bayne Type I or Type II, radius lengthening is accompanied by a soft-tissue distraction or release at the ulnar carpal joint with keeping wrist and forearm motion without producing growth plate damage.
桡侧多指（趾）畸形是上肢桡侧或轴前边界的一种复杂先天性异常。其表型范围广泛，从拇指发育不全到桡骨和第一掌骨完全缺如。肌腱转移中心化是维持桡侧多指（趾）畸形正确位置的常用方法。另一方面，人们设计了各种矫正方法，如牵引后桡骨化，以强调尺骨头位于桡腕骨下方，不再位于腕骨中心的槽内；微血管骨骺转移；使用伊里扎洛夫方法进行渐进矫正，适用于贝恩III型或IV型。我们应注意桡骨畸形的复发或因张力导致的循环障碍。可选择月骨切除或尺骨缩短以进行无张力矫正。桡骨化可用于避免桡骨屈曲的复发。然而，我们应注意尺骨头的桡侧突出。为避免桡骨畸形的复发或循环障碍，可采用伊里扎洛夫外固定进行渐进矫正，尤其是在桡侧严重偏斜或前臂短的病例中。在轻度病例，如贝恩I型或II型，桡骨延长时伴有尺腕关节的软组织牵引或松解，同时保持腕关节和前臂活动，且不造成生长板损伤。
