Liu Qianqian, Zhong Lei, Li Hong, Liu Jun, Zhu Zhe, Qu Wenrui, Li Rui
Department of Hand Surgery, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Changchun 130041, Jilin Province, China.
Joint Surgery Department, The Second Hospital of Jilin University, No. 218, Ziqiang Street, Changchun 130041, Jilin Province, China.
J Plast Reconstr Aesthet Surg. 2018 Dec;71(12):1717-1722. doi: 10.1016/j.bjps.2018.08.003. Epub 2018 Aug 24.
We aimed to detect whether percutaneous arthrography can provide detailed information for surgery for Wassel type IV thumb duplication prior to skin incision.
Percutaneous arthrography of the metacarpophalangeal (MP) joints was performed in eight infants. Of these, three patients had interphalangeal (IP) joints, in which thumb duplication at the MP joint (Wassel type IV) was detected on radiography. Based on the arthrographic findings, we designed the skin incision and determined whether and where osteotomies were required to correct the angular deformities before surgery.
Arthrography revealed the cartilaginous position and shape, shown as a black area on radiographs. Two patients demonstrated fibrous attachment between the proximal phalanx of the radial thumb and the capsule of the ulnar thumb. One patient had two completely separated MP joints. Cartilaginous connection between the two proximal phalanges was present in another two cases. The remaining three patients demonstrated a common joint between the duplicated proximal phalanges, sharing a common articular space with the MP joint, with the metacarpal head's surface forming two facets separated by a crease in the middle. IP joint arthrography was performed in three patients who presented with angular deformity.
Percutaneous arthrography can provide detailed information prior to skin incision. Furthermore, our arthrographic findings coincided with the practical situations we observed intraoperatively. Our experience indicates that preoperative percutaneous arthrography should be performed routinely in more cases and classified based on articular configuration to aid in the selection of surgical treatment.
我们旨在检测经皮关节造影术能否在皮肤切开前为瓦塞尔IV型拇指重复畸形手术提供详细信息。
对8例婴儿进行了掌指（MP）关节的经皮关节造影术。其中，3例患者有指间（IP）关节，在X线片上检测到MP关节处的拇指重复畸形（瓦塞尔IV型）。根据关节造影结果，我们设计了皮肤切口，并确定手术前是否需要以及在何处进行截骨术以纠正角畸形。
关节造影显示了软骨的位置和形状，在X线片上表现为黑色区域。2例患者显示桡侧拇指近节指骨与尺侧拇指关节囊之间有纤维连接。1例患者有两个完全分离的MP关节。另外2例患者的两个近节指骨之间存在软骨连接。其余3例患者显示重复的近节指骨之间有一个共同关节，与MP关节共享一个共同的关节间隙，掌骨头表面形成两个由中间折痕分隔的小平面。对3例出现角畸形的患者进行了IP关节造影。
经皮关节造影术可在皮肤切开前提供详细信息。此外，我们的关节造影结果与术中观察到的实际情况相符。我们的经验表明，术前应在更多病例中常规进行经皮关节造影术，并根据关节构型进行分类，以辅助手术治疗的选择。
