Tada K, Yonenobu K, Tsuyuguchi Y, Kawai H, Egawa T
J Bone Joint Surg Am. 1983 Jun;65(5):584-98.
Over a twenty-two-year period, 237 patients (261 hands) with duplication of the thumb were seen in the Hand Clinic of Osaka University Hospital. Two groups were identified: Group A, 141 patients without previous surgical treatment, and Group B, ninety-six patients with residual deformity despite previous surgical treatment. Using a modification of Wassel's classification, seven types of deformity were defined. In Group A these types were identified on the basis of the observed duplications of bone and soft tissue. In all but ten of the Group-B patients preoperative roentgenograms were not available and the type of deformity had to be deduced from the residual duplicated bone, the surgical scar, and the residual deformity. Surgery, performed on 193 hands (125 in Group A and sixty-eight in Group B), attempted to restore normal anatomical relationships. The results could be evaluated in 130 hands according to the range of motion, joint stability, and alignment of the remaining thumb after an average follow-up of 35.0 months. According to the rating system described, the results were rated as good in 75.5 per cent, fair in 20.2 per cent, and poor in 4.3 per cent of the ninety-four hands in Group-A patients who were followed. In the thirty-six hands of Group-B patients who could be followed, the preoperative and postoperative scores were compared. Thirteen were not improved while the other twenty-three, sixteen improved from fair to good and seven improved from poor to fair, to give a good result in 63.9 per cent of the Group-B patients who were followed. The results in these 130 Group-A and B hands emphasize the importance of providing muscle balance and, in young patients, of performing an arthroplasty of the interphalangeal or metacarpophalangeal joint when indicated, although arthrodesis was indicated as a salvage operation for Group-B patients who were more than fifteen years old.
在22年的时间里，大阪大学医院手部诊所共诊治了237例（261只手）拇指重复畸形患者。分为两组：A组，141例未经手术治疗的患者；B组，96例尽管此前接受过手术治疗但仍有残留畸形的患者。采用改良的瓦塞尔分类法，定义了七种畸形类型。在A组中，这些类型是根据观察到的骨骼和软组织重复情况确定的。除10例B组患者外，其余患者术前均未进行X线检查，畸形类型只能根据残留的重复骨骼、手术瘢痕和残留畸形推断。对193只手（A组125只，B组68只）进行了手术，试图恢复正常的解剖关系。平均随访35.0个月后，根据活动范围、关节稳定性和残留拇指的对线情况，对130只手的治疗结果进行了评估。根据所描述的评分系统，在接受随访的A组94例患者的94只手中，结果评为良好的占75.5%，一般的占20.2%，差的占4.3%。在B组36例可随访的患者中，比较了术前和术后的评分。13例无改善，其余23例中，16例从一般改善为良好，7例从差改善为一般，在接受随访的B组患者中，63.9%的患者结果良好。这130只A组和B组手的治疗结果强调了提供肌肉平衡的重要性，对于年轻患者，在有指征时进行指间关节或掌指关节成形术的重要性，尽管对于15岁以上的B组患者，关节融合术被视为挽救手术。
