Cole R J, Manske P R
Orthopaedic Clinic, Memphis, TN, USA.
J Hand Surg Am. 1997 May;22(3):479-88. doi: 10.1016/S0363-5023(97)80016-0.
Fifty-five ulnar-deficient upper extremities in 45 patients treated at the St. Louis Shriner's Hospital were reviewed in order to evaluate the hand abnormalities. Thumb and first-web abnormalities were noted in 73% of hands. The majority of operations (28 of 53) were recommended to improve functional deficits associated with abnormalities of the thumb and first web. A classification of the ulnar-deficient hand based upon the characteristics of the thumb and first web is presented. When used in combination with any of the six current forearm/elbow classification schemes, this classification more completely describes ulnar deficiency of the upper extremity. Four classification types are proposed based upon progressive involvement of the thumb and first web. In type A, the thumb and first web are normal; in type B, the first web space has mild deficiency and the thumb has mild involvement. Extrinsic tendon function is intact and opposition function is present. In type C, the thumb has varying degrees of involvement. The first web has moderate to severe deficiency, including thumb-index syndactyly, and is often associated with malrotation of the thumb into the plane of the other digits, loss of opposition, and dysfunction of the extrinsic tendons. In type D, the thumb is absent. Previous classifications of ulnar deficiency neglect the radial hand anomalies that have been noted by several authors in a high percentage of affected extremities. Our premise for this classification is that the thumb and first-web abnormalities are related to the complexity of the hand problem and that the frequently noted radial hand abnormalities require the majority of surgical procedures. Such a classification based on the thumb and first-web deformities will focus the surgeon's attention on those deficiencies that are most important for the restoration of function. It is proposed that ulnar deficiency be classified by one of the classification schemes that describes the anatomy of the forearm and/or elbow supplemented by the hand classification type.
为评估手部异常情况，对圣路易斯施莱纳医院收治的45例患者的55个尺骨缺损上肢进行了回顾性研究。73%的手部存在拇指和第一掌骨间隙异常。大多数手术（53例中的28例）旨在改善与拇指和第一掌骨间隙异常相关的功能缺陷。本文提出了一种基于拇指和第一掌骨间隙特征的尺骨缺损手部分类方法。当与现有的六种前臂/肘部分类方案中的任何一种结合使用时，这种分类方法能更全面地描述上肢的尺骨缺损情况。根据拇指和第一掌骨间隙的逐渐受累情况，提出了四种分类类型。A型中，拇指和第一掌骨间隙正常；B型中，第一掌骨间隙有轻度缺损，拇指有轻度受累。外在肌腱功能完整，对掌功能存在。C型中，拇指有不同程度的受累。第一掌骨间隙有中度至重度缺损，包括拇指-示指并指，且常伴有拇指旋转至其他手指平面、对掌功能丧失和外在肌腱功能障碍。D型中，拇指缺如。先前的尺骨缺损分类忽略了一些作者在高比例受累肢体中所指出的桡侧手部异常情况。我们进行这种分类的前提是，拇指和第一掌骨间隙异常与手部问题的复杂性相关，且常见的桡侧手部异常需要大多数手术操作。这种基于拇指和第一掌骨间隙畸形的分类将使外科医生的注意力集中在对功能恢复最重要的那些缺损上。建议通过描述前臂和/或肘部解剖结构的分类方案之一，并辅以手部分类类型来对尺骨缺损进行分类。
