Service de Chirurgie Infantile à Orientation Orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, 48 Boulevard Sérurier, 75019 Paris, France.
Service de Chirurgie Infantile à Orientation Orthopédique, Hôpital Universitaire Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, 48 Boulevard Sérurier, 75019 Paris, France.
Hand Surg Rehabil. 2021 Oct;40(5):670-674. doi: 10.1016/j.hansur.2021.04.011. Epub 2021 Apr 30.
Central ray amputation results severe esthetic blemish and functional and psychological sequelae. Three main reconstruction procedures have been reported in adults: digital translocation, intracarpal osteotomy, and metacarpal resection; none of these, however, have been studied in children. The aim of this study was to report medium-term results for treatment of central ray amputation by proximal metacarpal resection following failure of digit replantation in children (i.e., skeletally immature patients). All children consecutively operated on by metacarpal resection after failure of digit replantation for complete central ray amputation between 2012 and December 2017 were retrospectively included. The surgical procedure consisted in metacarpal resection through a palmar approach, with deep transverse metacarpal ligament reconstruction. At last follow-up, adjacent finger range of motion, pain, rotational deformity and grip strength were evaluated, as well as metacarpal laxity. Metacarpal migration index and metacarpal divergence were measured on standard X-ray. Eleven children with a mean age of 11 ± 8 years were included. At mean 18 ± 3 months' follow-up, range of motion in adjacent digits was conserved in all cases, with no intermetacarpal laxity. Grip strength was 28% lower than for the contralateral side. Two patients showed rotational malalignment in extension, without functional impairment. In 4th ray amputation (n = 8), metacarpal migration index was decreased by 65% due to radial migration of the 5th metacarpal, but metacarpal divergence was conserved in all cases. Isolated metacarpal resection of the central ray for replantation failure is a reliable and safe procedure with good radiological and functional results in skeletally immature children.
中央射线截肢会导致严重的外观缺陷以及功能和心理后遗症。在成年人中，已经报道了三种主要的重建程序：数字移位、腕骨切开术和掌骨切除术；然而，这些方法都没有在儿童中进行研究。本研究旨在报告儿童（即骨骼未成熟的患者）在手指再植失败后通过近节掌骨切除术治疗中央射线截肢的中期结果。回顾性纳入了 2012 年至 2017 年 12 月期间因完全中央射线截肢而手指再植失败后连续接受掌骨切除术的所有儿童。手术过程包括通过掌侧入路进行掌骨切除，并重建深部横掌骨韧带。末次随访时，评估了相邻手指的活动度、疼痛、旋转畸形和握力，以及掌骨松弛度。在标准 X 线上测量掌骨迁移指数和掌骨离散度。纳入了 11 名平均年龄为 11±8 岁的儿童。平均随访 18±3 个月后，所有病例相邻手指的活动度均得以保留，无掌骨间松弛。握力比对侧低 28%。2 例在伸展时出现旋转对线不良，但无功能障碍。在第 4 射线截肢（n=8）中，由于第 5 掌骨的桡侧迁移，掌骨迁移指数降低了 65%，但所有病例的掌骨离散度均得以保留。对于骨骼未成熟的儿童，手指再植失败后单独切除中央射线的掌骨是一种可靠且安全的方法，具有良好的影像学和功能结果。
