68例先天性拇指末节尺侧成角畸形的原因分析

发布时间：2018-10-11 10:54

【摘要】：目的探讨导致先天性拇指末节尺侧成角畸形的解剖学异常原因,鉴别诊断,并指导手术方式的选择。方法选取重庆医科大学附属儿童医院烧伤整形科病房2011年1月至2016年1月收治的先天性拇指末节尺侧成角畸形患儿68例91侧拇指,回顾性分析其临床表现、X线特征以及术中所见骨关节差异,分析引起该类畸形的异常解剖结构,总结鉴别诊断的方法,并随访不同手术方案的治疗效果。结果68例患儿91侧手中,55侧拇指为末节指骨骨骺肥大畸形,术前X片示骨骺与远节指骨对位较好,间距窄(平均0.83mm),治疗上均采用骨骺内楔形截骨矫正;36侧拇指为三指节拇指畸形,术前X片示多余指骨与远节指骨对位较差,间距较宽(平均2.81mm),治疗上采用摘除delta骨块或楔形截骨+远IP关节融合予以矫正。术后平均随访23个月,末节尺侧成角均得以改善。结论本组病例中,引起先天性拇指末尺侧成角的原因主要为拇指末节指骨骨骺肥大畸形,其次是三指节拇指畸形。术前X片上,肥大骨骺的骨化中心与末节指骨的间距窄且对位对线好是其与三指节拇指术前鉴别的要点,应依据其不同的病理解剖分类选择不同的手术方式。
[Abstract]:Objective to investigate the anatomical abnormality causes of ulnar diagonal malformation of the ulnar segment of the thumb, to differentiate the diagnosis, and to guide the choice of surgical methods. Methods from January 2011 to January 2016, 68 children with ulnar angular malformation of the distal thumb were selected from the Department of Burn and plastic surgery, affiliated Children's Hospital of Chongqing Medical University. The clinical manifestations, X-ray features and bone and joint differences during operation were analyzed retrospectively. The abnormal anatomical structure caused by this kind of malformation was analyzed, the methods of differential diagnosis were summarized, and the therapeutic effects of different surgical schemes were followed up. Results in 91 hands of 68 children, 55 thumbs were epiphyseal hypertrophy of the distal phalanx. The epiphysis and distal phalangeal bone were in good position on X ray before operation. The average distance (0.83mm) was narrow, and the treatment was corrected by intraepiphyseal wedge osteotomy, 36 thumbs were deformed by three-phalangeal thumb, and X-ray films before operation showed that the redundant phalanx and distal phalangeal bone were not in the same position as those of the distal phalangeal bone. The distance was wider (average 2.81mm). The removal of delta bone or wedge-shaped distal IP joint fusion was used to correct the treatment. The average follow-up was 23 months and the ulnar angle was improved. Conclusion the main causes of ulnar angle of the congenital thumb are epiphyseal hypertrophy of the distal phalanx of the thumb, followed by the thumb deformity of the third phalanx. On the X ray before operation, the narrow distance between the ossification center of hypertrophic epiphysis and the distal phalanx and the alignment of the distal phalanx were the key points to differentiate the thumb from the third phalanx before operation. Different surgical methods should be selected according to the different pathological anatomical classification of hypertrophic epiphysis.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R726.5

【相似文献】