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目的比较赘指切除加侧副韧带重建术和Bilhaut-Cloquet术两种术式治疗WasselⅡ型复拇指畸形的长期疗效,探讨合理的术式选择方法。方法回顾性研究了10例患儿(11指)WasselⅡ型复拇指畸形的病例,其中有3指复拇畸形采用Bilhaut-Cloquet方法治疗,8指采用赘指切除加侧副韧带重建方式进行矫治,手术时年龄为6个月～10岁。重点分析术后功能恢复和外观恢复情况。结果术后本组病例平均随访时间[(12.4±2.1)年,(?)±s,下同],两种术式都能获得比较好的拇指指间关节的稳定性;在拇指指间关节活动度方面,赘指切除加侧副韧带重建术后平均为(51.7±10.1)°,而Bilhaut- Cloquet术后平均为(11.7±9.3)°,两者差异有统计学意义。在拇、示指捏力方面两者差异无统计学意义。在患指术后末节指骨对线方面Bilhaut-Cloquet术具有一定的优势,但该术式术后均残留指甲的线状沟槽或突起。结论对于WasselⅡ型复拇指畸形宜早期采用赘指切除加侧副韧带重建术进行矫治,如果患儿年龄较大,两个末节指骨发育较均衡,可考虑采用Bilhaut-Cloquet术。
Objective To compare the long-term effects of resection plus lateral collateral ligament reconstruction and Bilhaut-Cloquet surgical treatment of Wassel Ⅱ complex thumb deformity, and to explore a reasonable surgical selection method. Methods A retrospective study was performed on 10 cases of Wassel Ⅱ complex thumb deformities. Among them, 3 cases were treated with Bilhaut-Cloquet for 3 cases, 8 cases were treated with excision of the thumb and lateral collateral ligament reconstruction, The age of surgery is 6 months to 10 years old. Focus on postoperative functional recovery and appearance recovery. Results The average duration of follow-up in this group was (12.4 ± 2.1) years (± s ± s, the same below). Both of the two procedures were able to obtain good stability of the thumb interphalangeal joint. In the thumb interphalangeal joint In terms of activity, the mean postoperative resection plus collateral ligament reconstruction was (51.7 ± 10.1) °, while the average Bilhaut-Cloquet was (11.7 ± 9.3) °, the difference was statistically significant. There was no significant difference between the thumbs and the thumbs. Bilhaut-Cloquet surgery has some advantages in the treatment of phalangeal alignment of the distal phalanges, but the operation still possesses linear grooves or protrusions of nail. Conclusions For Wassel type Ⅱ complex thumb deformity should be treated early with sub-radical resection and collateral ligament reconstruction for correction, if the children are older, the two distal phalanx development is more balanced, consider the use of Bilhaut-Cloquet surgery.