Glicenstein J, Guero S, Haddad R
Urgences Mains Enfants, Hôpital Robert Debré, Paris.
Ann Chir Main Memb Super. 1995;14(6):253. doi: 10.1016/s0753-9053(05)80404-1.
Based on a series of 29 patients with median clefts of the hand (29 hands), the authors define the place of this malformation, its various clinical features and the therapeutic indications. The series consists of 13 boys and 7 girls, 9 bilateral cases and 11 unilateral cases. Involvement of the feet was observed in 9 cases. Several children also presented other malformations. 16 children were operated (22 hands). Two types of technique were used: simple closure of the cleft (Barsky's operation) and transposition of the index finger according to the Snow-Littler or Miura-Komada techniques. All operated patients were reviewed with a follow-up of more than one year and the results were assessed in terms of three criteria: overall use of the hand, thumb-index finger pinch grip, aesthetic appearance. The authors propose a new classification of median clefts of the hand based on examination of this series of 20 children: simple clefts with more or less complete absence of the middle finger, complex clefts with syndactyly (especially I and II), transverse bone polydactyly, extensive clefts with severe aplasia of the radial segment of the hand. Clinical and radiological examination confirm the experimental studies by Ogino. Barsky's operation gives satisfactory results in simple forms with parallel fingers. Translocation of the index finger to the base of the 3rd metacarpal is necessary in the presence of divergent fingers and syndactyly. Median clefts of the hand are very distinct from median aplasia, which is always unilateral, with no familial nature and no involvement of the feet and which can be classified together with brachysyndactyly. Each case must be studied before deciding treatment, as functional adaptation is always remarkable. The least favourable surgical results are observed in forms with abnormal position of the index finger (malrotation syndactyly). Lastly, the Snow-Littler operation is not devoid of complications.
基于29例手部正中裂（29只手）患者的系列研究，作者明确了这种畸形的位置、各种临床特征及治疗指征。该系列包括13名男孩和7名女孩，9例双侧病例和11例单侧病例。9例观察到足部受累。部分儿童还存在其他畸形。16名儿童接受了手术（22只手）。采用了两种手术技术：单纯裂隙闭合术（巴尔斯基手术）以及根据斯诺-利特勒或三浦-小田技术进行的示指转位术。对所有接受手术的患者进行了随访，随访时间超过一年，并根据三个标准评估结果：手部的整体使用情况、拇指-示指捏握、美观外观。作者基于对这20例儿童的检查结果，对手部正中裂提出了一种新的分类：简单裂隙，中指或多或少完全缺失；复杂裂隙伴并指（尤其是示指和中指）、横向多指畸形、广泛裂隙伴手部桡侧严重发育不全。临床和放射学检查证实了荻野的实验研究结果。巴尔斯基手术对于手指平行的简单类型能取得满意效果。存在手指分开和并指时，将示指转位至第三掌骨基部是必要的。手部正中裂与正中发育不全非常不同，正中发育不全总是单侧的，无家族性，不累及足部，可与短指并指归为一类。在决定治疗方案前，必须对每个病例进行研究，因为功能适应性通常很显著。示指位置异常（旋转不良并指）的类型手术效果最差。最后，斯诺-利特勒手术并非没有并发症。
