Ganley T J, Lubahn J D
Department of Orthopaedics, Hamot Medical Center, Erie, PA 16550, USA.
Ann Plast Surg. 1995 Jul;35(1):86-9. doi: 10.1097/00000637-199507000-00017.
Radial polydactyly is a relatively common congenital disorder that frequently occurs as thumb duplication. A paucity of information exists on outcomes of Bilhaut-Cloquet procedures. To evaluate clinical outcomes, the results of various operative and nonoperative treatments were reviewed. Follow-up by retrospective chart review was performed on 21 patients treated between 1979 and 1994 at the Shriners Hospital for Crippled Children in Erie, Pennsylvania. Patient interview or physical examination, or both, was performed on 16 of these patients. The study was comprised of 9 boys and 12 girls (average age, 7.8 years; range, 1.5-15.8 years) and included 26 thumbs. Ablation alone was performed in 6 thumbs (6 patients), a combined procedure consisting of ablation with radial collateral ligament reconstruction and shaving of the metacarpal in 10 thumbs (9 patients), and a Bilhaut-Cloquet procedure in 5 thumbs (4 patients). Five thumbs (4 patients) with Wassel type I classification were managed without surgical intervention and simply observed. Of the 6 thumbs treated with ablation alone, 5 required subsequent procedures (radial collateral ligament reconstruction). Ablation with collateral ligament reconstruction and articular surface shaving improved clinical alignment and stability but did not return normal interphalangeal joint motion. The Bilhaut-Cloquet procedure improved the overall cosmetic and functional appearance but likewise did not restore normal joint motion. Our findings support current literature that finds that ablation of the thumb without reconstruction is contraindicated because of the high reoperation rate. Although techniques have evolved that improve alignment and stability or appearance, none guarantee normal joint motion. All patients were satisfied, however, that the thumb was significantly improved compared with the preoperative condition.
桡侧多指畸形是一种相对常见的先天性疾病，常表现为拇指重复畸形。关于Bilhaut-Cloquet手术的结果，目前可用信息较少。为了评估临床结果，我们回顾了各种手术和非手术治疗的结果。通过回顾性病历审查，对1979年至1994年期间在宾夕法尼亚州伊利市的施莱宁儿童医院接受治疗的21例患者进行了随访。对其中16例患者进行了患者访谈或体格检查，或两者皆有。该研究包括9名男孩和12名女孩（平均年龄7.8岁；范围1.5 - 15.8岁），共涉及26个拇指。单纯切除6个拇指（6例患者），10个拇指（9例患者）采用切除联合桡侧副韧带重建及掌骨修整的联合手术，5个拇指（4例患者）采用Bilhaut-Cloquet手术。5个Wassel I型分类的拇指（4例患者）未进行手术干预，仅进行观察。在仅接受切除治疗的6个拇指中，有5个需要后续手术（桡侧副韧带重建）。切除联合副韧带重建及关节面修整改善了临床对线和稳定性，但未恢复正常的指间关节活动。Bilhaut-Cloquet手术改善了整体外观和功能，但同样未恢复正常的关节活动。我们的研究结果支持当前文献的观点，即由于再次手术率高，不进行重建的拇指切除是禁忌的。尽管技术已经有所发展，能够改善对线、稳定性或外观，但没有一种技术能保证恢复正常的关节活动。然而，所有患者都对拇指与术前状况相比有显著改善感到满意。
