【摘要】 目的观察第2掌骨纵向半侧骨干移位和二期拇对掌功能重建治疗改良Blauth 3B和3C型拇指发育不良的疗效。方法 2013年12月至2018年6月,复旦大学附属华山医院手外科收治的改良Blauth3B和3C型患儿资料12例。将第2掌骨纵向半侧移位延长第1掌骨,稳定第一腕掌关节。确认骨折愈合后,二期行肌腱移位拇对掌功能重建术。术后评估掌骨愈合情况,有无并发症。使用Percival拇指功能评估法,从握力、捏力、对掌、感觉、活动范围、外观等几个方面,评估拇指功能。结果平均随访3.4年,12例患者中,9例达到一期掌骨愈合;2例发生第1掌骨骨不连;1例发生第2掌骨骨折;后二者均在二期手术时一并修复并最终愈合。通过Percival评分,6例优秀,3例良好,3例一般。结论第2掌骨纵向半侧移位结合拇对掌功能重建的手术,可有效重建改良Blauth 3B及3C型发育不良拇指,既保留拇指又能重建较好的功能,远期疗效需要更多随访。更多还原

【Abstract】 Objective To assess the outcomes of the treatment of reconstruct for modified Blauth 3B and 3C hypoplastic thumbs by hemi-longitudinal second metacarpal and opposition tendon transfer. Methods From December 2013 to June 2018,12 children with modified Blauth 3B or 3C hypoplastic thumbs were treated in Department of Hand Surgery, Huashan Hospital, Fudan Vniversity. The treatment included two phases. In the first phase, the short metacarpal was lengthened and the unstable first carpometacarpal joint was reconstructed by hemi-longitudinal second metacarpal transfer. The second phase of the treatment was conducted 3 months after confirming the union of the bone. Union of the metacarpal, complications were observed. Their pinch, opposition, grasp, mobility, sensibility and cosmetic appearance were measured. Percival’s assessment of pollicization was used. The function of pinch, opposition, grasp, mobility, sensibility, cosmetic appearance were assessed to each thumb. Result The outcomes were measured after 3.4 years in average. Nine children reached the union of the first metacarpal. Nonunion of the first metacarpal occurred in 2 patients and fracture of the second metacarpal occurred in 1 patient. The nonunion and fracture were cured in the second phase of the treatment. Six patients reached excellent grades; three reached good grades and three got fair grades. Conclusion The hemi-longitudinal second metacarpal transfer with second stage tendon transfer is an effective procedure to reconstruct a functional thumb in patients with modified Blauth 3B and 3C hypoplastic thumbs. Using this method, the thumb was preserved with relatively good function. Long-term outcomes need further follow-up.更多还原