用无血管趾骨骨节移植替代髓核切除术治疗唐氏 3B 型拇指发育不良症的长期功能和放射学结果。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume Pub Date : 2025-10-01 DOI:10.1016/j.jhsa.2024.06.011

Anil K. Bhat MS(Ortho), DNB(Ortho) , Ashwath M. Acharya MS, FNB , Mithun Pai G MS, FNB

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引用次数: 0

摘要

目的：拇指发育不良患儿的家长往往出于各种原因拒绝接受拇指接骨术，并询问是否有其他选择。我们的研究旨在评估因通金 3B 型拇指发育不良而接受无血管趾骨移植手术的儿童的治疗效果，并将其与接受拇指接骨术治疗的同类儿童进行比较：在平均 7 年的趾骨转位随访和 6 年的拇指接骨术随访中，对每组中的 5 名儿童进行了拇指长度、第一腕掌骨 (CMC) 关节稳定性、活动度、对抗性和供体部位发病率测试。并要求家长报告孩子在功能和外观方面的改善情况。所有病例均为唐金 3B 型拇指发育不良：所有患儿的CMC关节均保持稳定，3名患儿的Kapandji评分为6分，2名患儿的Kapandji评分为5分，而所有患儿的Kapandji评分均为9分。趾骨转位组患儿的平均掌外展为24°，平均桡外展为36°，而患儿的掌外展和桡外展分别为40°和45°。趾骨转位组的拇指平均长度为食指近节指骨的 50.8%，而桡侧趾骨转位组的拇指平均长度为食指近节指骨的 60%。拇指功能和外观的平均视觉模拟量表评分分别为 6.8 分和 6.4 分，而接骨组分别为 9.2 分和 8.8 分。在平均7年的随访中，未发现供体指骨吸收，除脚趾轻度缩短外，供体部位无其他病变：结论：我们注意到接骨组的掌外展和桡侧外展增加。在最长的 9 年随访中，未发现供体趾骨发生吸收。对于那些优先考虑五指手的儿童来说，可以考虑采用趾骨移植术：治疗V.

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Long-Term Functional and Radiological Results in Tonkin Type 3B Thumb Hypoplasia Treated With Nonvascularized Toe Phalanx Transfer as an Alternative to Pollicization

Purpose

Parents of children with hypoplastic thumbs often reject the option of pollicization for various reasons and enquire about alternate choices. Our study aimed to assess the outcome in children who underwent nonvascularized toe phalanx transfer for Tonkin type 3B thumb hypoplasia and compare it with a similar cohort of children treated with pollicization.

Methods

At an average follow-up of 7 years for toe phalanx transfer and 6 years of pollicization, five children from each group were tested for thumb length, stability of the first carpometacarpal (CMC) joint, mobility, opposition, and donor-site morbidity. Parents were asked to report improvements in function and appearance. All cases were Tonkin type 3B thumb hypoplasia.

Results

The CMC joint was found to be stable in all children, and the Kapandji score was 6 in 3 children and 5 in 2 children with toe phalanx transfer compared to 9 in all children with pollicization. The average palmar abduction was 24°, and the average radial abduction was 36° in the toe phalanx transfer group compared to 40° and 45°, respectively, in children with pollicization. The average thumb length was 50.8% of the index finger's proximal phalanx in the toe phalanx group compared to 60 % in the pollicization group. The mean visual analog scale scores for the thumb's function and appearance were 6.8 and 6.4, respectively, compared to 9.2 and 8.8, respectively, in the pollicization group. No resorption was noted in the donor phalanx at a mean follow-up of 7 years with no donor-site morbidity other than mild shortening of the toes.

Conclusions

We noted increased palmar abduction and radial abduction in the pollicization group. No resorption was noted in the donor toe phalanx at the longest follow-up of 9 years. Toe phalanx can be considered an alternative for those children in whom a five-finger hand is a priority.

Type of study/level of evidence

Therapeutic V.

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来源期刊

Journal of Hand Surgery-American Volume 医学-外科

CiteScore

3.20

自引率

10.50%

发文量

402

审稿时长

12 weeks

期刊介绍： The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.