Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas.
Department of Neurology, University of Campinas (UNICAMP), São Paulo, Brazil.
J Craniofac Surg. 2023 Jun 1;34(4):1170-1173. doi: 10.1097/SCS.0000000000009107. Epub 2022 Nov 1.
The Upton type III hand, which represents the most severe hand type among Apert syndrome patients, has been considered the least prevalent hand type. The objective of this study is to address type III Apert hand prevalence and describe treatment strategies that will result in a 5 digit hand.
The authors retrospectively reviewed 15 years of Apert syndrome hand practice at our hospital. Demographic (patient sex and age at the time of the operation), surgical (eg, techniques used for webspace release, osteotomy, and various aspects of soft-tissue reconstruction), and outcome (perioperative and long-term complication and need for revision operation) data was verified through medical records, clinical photographs, radiographic images, and interviews with patients' families. Patients who had incomplete medical records and/or postoperative follow up <6 months in length were excluded from this study.
A total of 93 Apert patients [50 male (56.1%) and 43 female (43.9%)] were treated at our hospital from 2007 to 2021. Stratification of Apert hand severity using Upton's classification system identified 34 patients with type I hands (36.4%), 19 patients with type II hands (20.6%), and 40 patients with type III hands (43%). Of the 40 patients with type III hands a 5 digit hand was achieved for 35 patients (87%), with an average of 3.37 operations per patient.
The Upton type III hand is the most prevalent hand type among Apert syndrome patients. Following a three stage protocol, a surgical team can consistently achieve a 5 digit hand for the majority of Apert syndrome patients with type III hands.
Upton Ⅲ型手是 Apert 综合征患者中最严重的手型，被认为是最不常见的手型。本研究旨在探讨 Upton Ⅲ型 Apert 手的患病率，并描述可获得 5 指手的治疗策略。
作者回顾性分析了我院 15 年来 Apert 综合征手部手术的临床资料。通过病历、临床照片、影像学图像和对患者家属的访谈，对患者的人口统计学（患者的性别和手术时的年龄）、手术（例如，用于蹼状松解、截骨和各种软组织重建的技术）和结果（围手术期和长期并发症以及需要进行修正手术）数据进行了验证。本研究排除了病历不完整和/或术后随访时间<6 个月的患者。
2007 年至 2021 年，我院共收治 93 例 Apert 患者[男 50 例（56.1%），女 43 例（43.9%）]。采用 Upton 分类系统对 Apert 手严重程度进行分层，发现 34 例 I 型手（36.4%）、19 例 II 型手（20.6%）和 40 例 III 型手（43%）。在 40 例 III 型手中，35 例（87%）获得了 5 指手，平均每例患者进行了 3.37 次手术。
Upton Ⅲ型手是 Apert 综合征患者中最常见的手型。通过三阶段方案，手术团队可以为大多数 Apert 综合征患者中的 III 型手患者提供 5 指手。
