手部桡侧多指畸形患者尺侧骨切除和桡侧骨重建的手术结果。
Surgical Results of Ulnar Component Excision and Radial Component Reconstruction in Patients With Preaxial Polydactyly of the Hand.
机构信息
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
出版信息
J Hand Surg Am. 2023 Aug;48(8):829.e1-829.e9. doi: 10.1016/j.jhsa.2022.01.029. Epub 2022 Mar 27.
PURPOSE
Resection of the underdeveloped digit and reconstruction of the robust digit is the standard treatment option for preaxial polydactyly of the hand. As an underdeveloped digit, the radial component is usually excised, whereas the ulnar component excision is rarely needed. This study aimed to evaluate the surgical results of ulnar component excision and radial component reconstruction in patients with preaxial polydactyly of the hand.
METHODS
We retrospectively reviewed the medical records and radiographs of 809 patients (861 thumbs) who underwent surgery for preaxial polydactyly of the hand from November 2006 to June 2018. Among these, 22 (2.6%) thumbs in which the ulnar component was more hypoplastic or had more severe deformities than the radial component were treated with ulnar component excision and radial component reconstruction. The mean follow-up duration was 49 months (range, 12-142 months). We evaluated the Japanese Society for Surgery of the Hand scores and whether the patients were satisfied with the thumb function and appearance at the final follow-up. We also recorded any complications, such as reoperation.
RESULTS
The mean Japanese Society for Surgery of the Hand score was 12.8 (range, 5-17). Six patients had poor results, 7 had fair results, and 2 had good results; however, none of the patients had an excellent result. Satisfaction with thumb function and appearance was reported in 11 (50%) and 6 (27%) cases, respectively. Thirteen of 22 (59.1%) cases involved reoperations, and the most common reason for reoperation was interphalangeal joint deviation of the remaining thumb.
CONCLUSIONS
Ulnar component excision and radial component reconstruction are rare operative choices in preaxial polydactyly of the hand. Surgeons and patients should be aware that a considerable number of patients treated with this method required reoperations and had low clinical outcome scores.
TYPE OF STUDY/ LEVEL OF EVIDENCE: Prognostic IV.
目的
对于手部轴前多指畸形，切除发育不良的手指并重建强壮的手指是标准的治疗选择。作为发育不良的手指，通常会切除桡侧成分，而很少需要切除尺侧成分。本研究旨在评估手部轴前多指畸形患者中尺侧成分切除和桡侧成分重建的手术结果。
方法
我们回顾性分析了 2006 年 11 月至 2018 年 6 月期间因手部轴前多指畸形接受手术治疗的 809 例患者（861 个拇指）的病历和 X 线片。其中，22 个拇指的尺侧成分比桡侧成分更发育不良或畸形更严重，采用尺侧成分切除和桡侧成分重建治疗。平均随访时间为 49 个月（范围 12-142 个月）。我们评估了日本手外科学会评分，以及患者在最终随访时对拇指功能和外观的满意度。我们还记录了任何并发症，如再次手术。
结果
日本手外科学会评分的平均得分为 12.8 分（范围 5-17 分）。6 例患者结果较差，7 例患者结果一般，2 例患者结果良好；但无患者结果为优秀。11 例（50%）患者对拇指功能满意，6 例（27%）患者对拇指外观满意。22 例中有 13 例（59.1%）需要再次手术，最常见的再次手术原因是残留拇指指间关节偏斜。
结论
手部轴前多指畸形中，尺侧成分切除和桡侧成分重建是罕见的手术选择。外科医生和患者都应该意识到，相当一部分接受这种方法治疗的患者需要再次手术，且临床结果评分较低。
研究类型/证据水平：预后 IV 级。
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