From the Shriners Hospitals for Children-Boston; Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School; and Division of Plastic Surgery, Department of Surgery, University of New Mexico, School of Medicine.
Plast Reconstr Surg. 2022 Apr 1;149(4):691e-699e. doi: 10.1097/PRS.0000000000008929.
The thumbs of patients with Apert syndrome are characteristically short and radially deviated, contributing to functional hand impairment. The authors report a two-staged technique for distraction lengthening of the Apert thumb using a robust cohort of pediatric patients.
The authors retrospectively reviewed medical records of pediatric patients with Apert syndrome who underwent thumb distraction lengthening between 1999 and 2019. The technique was two-staged: (1) application of uniplanar distractor and phalangeal osteotomy, followed by (2) distractor removal, bone grafting, and fixation. Clinical records, preoperative and postoperative radiographs, and photographs were reviewed.
Twenty-two patients (41 thumbs) with Apert syndrome were identified and treated (mean age at initial distraction, 11.5 years). A mean distraction gap of 31.3 mm was achieved over a median time of 40.0 days. The mean healing index was 26.3 days per centimeter. The thumbnail complex was lengthened a median length of 3.0 mm. The median follow-up time was 5.0 years, with complications occurring in 36.4 percent (eight out of 22) of patients. A delayed bone union occurred in one patient, and rotational malunion occurred in one patient.
Although long-term outcomes data are needed, thumb distraction lengthening following syndactyly release in patients with Apert syndrome is safe and should be considered to augment the overall appearance and functionality of the hand.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Apert 综合征患者的拇指通常较短且向桡侧偏斜，导致手部功能受损。作者报告了一种使用大量儿科患者进行 Apert 拇指分步牵引延长的技术。
作者回顾性分析了 1999 年至 2019 年间接受拇指牵引延长术的 Apert 综合征儿科患者的病历。该技术分两阶段进行：（1）应用单平面牵开器和指骨截骨术，然后（2）去除牵开器、植骨和固定。回顾了临床记录、术前和术后 X 线片和照片。
确定并治疗了 22 例（41 个拇指）Apert 综合征患者（初次牵引时的平均年龄为 11.5 岁）。平均延长间隙为 31.3mm，中位数时间为 40.0 天。平均愈合指数为每厘米 26.3 天。拇指复合体长延长了 3.0mm，中位数随访时间为 5.0 年，36.4%（22 例中的 8 例）的患者发生并发症。1 例发生延迟性骨愈合，1 例发生旋转性畸形愈合。
尽管需要长期结果数据，但 Apert 综合征患者在并指松解后进行拇指牵引延长是安全的，应考虑改善手部的整体外观和功能。
临床问题/证据水平：治疗，IV。
