Guero S, Haddad R, Glicenstein J
Service d'Orthopédie-Traumatologie, Hôpital Necker-Enfants Malades, Paris.
Ann Chir Main Memb Super. 1995;14(6):272-83. doi: 10.1016/s0753-9053(05)80406-5.
The surgical treatment of thumb duplication remains difficult, the sequelae usually observed are aesthetic (ungual dystrophy, hypoplastic pulp, clinodactyly) or functional (joint stiffness or instability). In order to clarify our therapeutic approach, we classify duplications into two types: proximal duplications (Wassel stage IV, V and VI) and distal duplications (Wassel stage I, II and III). Our experience is based on 106 cases operated over the last 15 years (1977). Our indications and operative techniques have progressed since 1988, in particular, we no longer perform Bilhaut-Cloquet operation, and prefer to perform the first operation before the age of one year. Resection of the hypoplastic supernumerary thumb. Preservation of the pulp skin to reconstitute the paronychium and pulp of the remaining thumb. Resection of supplementary joint facets. Meticulous repair of the capsulo-ligamentus apparatus by means of a capsulo-periosteal flap taken from the "sacrificed" thumb. Tendinous reequilibration and reinsertion of thenar muscles. We do not perform systematic subcapital osteotomy. When necessary, this procedure is performed during a complementary operation at the age of 2 to 3 years. Since the introduction of these technical modifications, our functional and aesthetic results have improved. Temporary overcorrection of the pulp is necessary. Parents must be advised that this deliberately hypertrophic appearance becomes normal with growth.
拇指重复畸形的手术治疗仍然具有挑战性，常见的后遗症包括美观问题（指甲营养不良、指腹发育不全、手指向尺侧偏斜）或功能问题（关节僵硬或不稳定）。为了阐明我们的治疗方法，我们将重复畸形分为两种类型：近端重复畸形（瓦塞尔IV、V和VI型）和远端重复畸形（瓦塞尔I、II和III型）。我们的经验基于过去15年（1977年）所做的106例手术。自1988年以来，我们的手术指征和技术有了改进，特别是我们不再进行比尔奥-克洛凯手术，并且更倾向于在一岁前进行首次手术。切除发育不全的多指。保留指腹皮肤以重建残留拇指的甲沟和指腹。切除多余的关节面。通过取自“牺牲”拇指的骨膜瓣仔细修复关节囊韧带结构。平衡肌腱并重新附着大鱼际肌。我们不进行常规的拇指近节指骨截骨术。必要时，该手术在2至3岁时的补充手术中进行。自从引入这些技术改进后，我们的功能和美观效果都有所改善。指腹需要暂时过度矫正。必须告知家长，这种故意造成的肥厚外观会随着生长而恢复正常。
