摘要
目的分析伴有2个重复趾并连以及主趾内翻畸形的轴前型多趾的解剖特点,并探讨相应的手术整复方案及其效果。方法收集2010年1月至2020年1月重庆医科大学附属儿童医院烧伤整形外科收治的一类特殊轴前型多趾病例资料,患者表现为重复的趾皮肤并连,有主、副趾之分,胫侧趾发育不良,腓侧为主趾但均伴明显的内翻畸形。分析此类畸形的解剖特点、手术切口设计、骨关节矫正方式并随访术后趾轴向以及对行走功能的影响。结果共纳入该类轴前型多趾患儿10例(12个趾),其中男6例,女4例;年龄5~45个月,平均19.3个月;单侧8例,双侧2例。所有病例均为重复趾完全并连、胫侧趾发育不良且向近端移位,腓侧趾为主趾但不同程度内翻(内翻角度25°~90°,平均55°)。术中见趾外展肌止点附着于胫侧趾,连带并连的主趾跖趾关节向内侧脱位,并伴有跖趾关节面的倾斜。手术切口设计:3趾内翻角度25°~40°,采用环绕多趾的齿状切口;3趾内翻角度45°~90°,采用多趾近端蒂皮瓣切口;6趾内翻角度75°~90°,采用双Z成形切口。骨关节矫正方式:多趾切除后,2趾的轻度内翻在经松解主趾胫侧挛缩软组织、趾关节复位后,轴向获得矫正;其余10趾行跖骨或趾骨胫侧撑开式截骨后,轴向获得矫正,其中9趾骨缺损行楔形植骨。创面闭合方式:全部患趾的手术创面均顺利关闭,其中采用多趾近端蒂皮瓣转移的3趾中有2趾因皮肤不足,行植皮补充;采用双Z成形切口的6趾,虽然内翻角度大,但经延长胫侧纵向皮肤后均能完全关闭创面。术后2例失访,其余8例(10趾)随访5~38个月(平均13个月),除1趾内翻矫正不足(内翻15°),2趾矫枉过正(外翻15°、20°),其余趾轴向正常;所有病例穿鞋行走正常。结论趾外展肌止于发育不良的胫侧趾,连带并连的主趾跖趾关节向内侧脱位导致内翻,并伴有跖趾关节面的倾斜是这类轴前型多趾的解
Objective To analyze and report the anatomical characteristics,surgical management and clinical outcome for preaxial polysyndactyly with varus deformity.Methods We retrospectively reviewed our database of cases with preaxial polysyndactyly in the Department of Burn and Plastic Surgery of Children’s Hospital of Chongqing Medical University from January 2010 to January 2020.The clinical manifestations are duplicated hallux,with complete fusion of the main and auxiliary hallux,tibial hallux dysplasia,and fibular hallux with obvious varus deformity.The anatomical characteristics of this special polysyndactyly,surgical incision design,osteoarticular correction methods were analyzed,and the axial line of the big toe after the operation and its influence on the walking function were followed up.Results A total of 10 children with preaxial polysyndactyly(12 toes)were enrolled,including 6 male and 4 female patients.Age ranged from 5 to 45 months,with an average of 19.3 months.Eight cases were unilateral,and 2 cases were bilateral.All the cases had duplicated hallux,with tibial hallux dysplasia and proximal displacement.The fibular hallux was dominant but with varus deformity to varying degrees(varus angle 25°-90°,mean 55°).During the operation,the abductor hallucis(AbdH)was found to be attached to the tibial hallux,and the metatarsophalangeal(MTP)joint of the dominant hallux was dislocated to the tibial side,with an inclination of the joint surface.Incision design:zigzag incision around extra toes were used in 3 toes with varus angle from 25°-40°,proximal pedicle flap of the extra toe was taking in 3 toes with varus angle from 45°-90°,and double Z-plasty incision was designed in 6 toes which varus angle is from 75°-90°.Correction of bone and joint:after extra toe resected,the axis of two cases with mild hallux varus was corrected by releasing the soft tissue contracture in the tibial side of the main toe and reducing the joint.The other 10 cases were obtained completely axially corrected after opening osteotomy
作者
李天武
梅爱莲
傅跃先
邱林
田晓菲
Li Tianwu;Mei Ailian;Fu Yuexian;Qiu Lin;Tian Xiaofei(Department of Burn and Plastic Surgery,Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Children’s Hospital of Chongqing Medical University,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)
出处
《中华整形外科杂志》
CSCD
2021年第9期987-992,共6页
Chinese Journal of Plastic Surgery
关键词
轴前型多并趾畸形
趾内翻
双Z成形
Preaxial polysyndactyly of foot
Hallux varus
Double Z-plasty
