Graham T J, Louis D S
Department of Orthopaedic Surgery, Cleveland Clinic Foundation, OH 44195, USA.
J Hand Surg Am. 1998 Jan;23(1):3-13. doi: 10.1016/s0363-5023(98)80081-6.
In order to adequately identify pathologic anatomy and effectively reconstruct 14 type IIIA hypoplastic thumbs, a comprehensive clinical evaluation and surgical approach was employed. Eleven patients had congenital differences in the forearm, while all patients had anomalies in the wrist, hand, and digits. In addition to well-described interconnections between the flexor pollicis longus and the extensor pollicis longus, and thenar muscle hypoplasia, the authors observed duplication of musculotendinous units, anomalous muscles between the thumb and index rays, and abnormal insertions or dense adhesions along tendons as proximal as the forearm level. Successful reconstruction required an extended approach from the digit to the forearm, through which division of abnormal connections, reorientation of tendons, and lysis of adhesions was performed. Opposition transfer was needed in only 8 of the patients after the other pathologies were treated. Web-space deepening and ulnar collateral ligament reconstruction was performed when indicated. Improvement in function and appearance was achieved.
为了充分识别病理解剖结构并有效重建14例ⅢA型发育不全拇指，我们采用了全面的临床评估和手术方法。11例患者在前臂存在先天性差异，而所有患者在腕部、手部和手指均有异常。除了已详细描述的拇长屈肌与拇长伸肌之间的连接以及大鱼际肌发育不全外，作者还观察到肌腱肌肉单位的重复、拇指与示指之间的异常肌肉、以及在前臂水平近端沿肌腱的异常附着或致密粘连。成功的重建需要从手指到前臂的扩展手术入路，通过该入路进行异常连接的分离、肌腱重新定向和粘连松解。在治疗其他病变后，仅8例患者需要进行对掌转移。必要时进行虎口加深和尺侧副韧带重建。功能和外观均得到改善。
