[摘要]目的：探讨掌骨嫁接结合软组织重建术在Wassel Ⅵ型复拇畸形整复中的应用效果。方法：以2014年1月-2018年12月笔者医院收治的20例（20拇）Wassel Ⅵ型复拇畸形患儿为研究对象，均施掌骨嫁接结合软组织重建术，术后至少随访12个月。采用体格检查、X线及日本手外科协会（Japanese Society for Surgery of the Hand，JSSH）评分表对患儿重建拇指的外观、功能及稳定性进行评估。结果：20例患儿术后均获得完整随访，随访时间15～42（32.16±8.33）个月，截骨端均在术后6周得到理想愈合;掌骨长度占健侧的比例为（90.54±2.13）%，2例患儿出现10°的指间关节主动伸直功能受限，2例患儿出现17°的掌指关节桡偏;末次随访时的JSSH评分为（20.08±0.40）分，优15例，良5例，优良率为100%。结论：掌骨嫁接结合软组织重建术在Wassel Ⅵ型复拇畸形整复中具有理想的手术效果，可以作为该类复拇畸形的术式选择。

[关键词]复拇畸形;Wassel Ⅵ型;掌骨嫁接;软组织重建;畸形修复;整形外科

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2020）08-0075-02

Application of Metacarpal Grafting Combined with Soft Tissue Reconstruction in the Treatment of Wassel Type Ⅵ Thumb Duplication

HUANG Chui-ming

（Department of Pediatric Surgery，Hainan People's Hospital，Haikou 570311，Hainan，China）

Abstract： Objective  To discuss the application effect of metacarpal grafting combined with soft tissue reconstruction in the treatment of Wassel type Ⅵ thumb duplication. Methods  A total of 20 children （20 thumbs） with Wassel type Ⅵ thumb duplication who were taken as research objects in our hospital from January 2014 to December 2018. All the children were carried out metacarpal grafting combined with soft tissue reconstruction. The children were followed up for at least 12 months. Physical examination， X-ray and the Japanese Society for Surgery of the Hand （JSSH） scores were used to evaluate the appearance， function and stability of the reconstructed thumbs. Results  All the 20 children were completely followed up for 15-42 （32.16±8.33） months after surgery， and the osteotomy ends were healed well 6 weeks after surgery. The ratio of metacarpal bone length to the healthy side was （90.54±2.13）%. Two children had 10? of limited active extension of the interphalangeal. Two children had 17? of radial deviation of the metacarpophalangeal. At the last follow-up， the JSSH scores were （20.08±0.40） scores， with 15 excellent cases and 5 good cases， with an excellent and good rate of 100%. Conclusion  Metacarpal grafting combined with soft tissue reconstruction had ideal surgical effect for Wassel type Ⅵ thumb duplication. It could be used as a surgical option for this type of thumb duplication.

Key words： thumb duplication; Wassel type Ⅵ; metacarpal grafting; soft tissue reconstruction; deformity repair; plastic surgery

復拇畸形又称桡侧多指，表现为正常拇指以外的挛生手指，也可以是手指的指骨、单纯软组织成分或掌骨等的赘生，是临床上最常见的手部先天性畸形之一，其发生率为0.08‰～0.18‰[1-2]。复拇畸形的发生受遗传因素和环境因素双重作用。复拇畸形的治疗目的是尽可能恢复其正常的解剖结构，达到外形和功能的重建，治疗原则是切除赘生拇指，保留近似正常的存留拇指[3-4]。目前多采用以解剖形态异常为基础的Wassel分类法，Wassel Ⅵ型复拇畸形属于掌骨复指型，患病率并不高，但临床治疗比较棘手[5]。近年来，笔者科室采用掌骨嫁接结合软组织重建术治疗Wassel Ⅵ型复拇畸形，并取得了较好的效果，现报道如下。……