摘要
目的探讨精确定位的骨骺内楔形截骨治疗儿童先天性拇指末节骨骺肥厚畸形的临床效果。方法回顾性分析2020年1月至2023年1月在东莞市中西医结合医院采用精确定位的骨骺内楔形截骨方式治疗先天性拇指末节骨骺肥厚畸形的患儿资料。术前X线片均表现为次级骨化中心不对称增厚,骨骺分别呈三角形、椭圆形、不等边梯形以及双骨骺融合状。术中精确定位,在距离关节面1.5 mm处楔形截骨,根据肥厚骨骺的形态以及远、近端指骨的综合情况调整截骨角度及截骨量,轴向过矫正约10°固定。术后6个月随访拇指末节侧偏角度、最大被动屈曲角度,并测量X线片中的末节骨骺厚度。对术前、术后数据行配对t检验,P<0.05为差异有统计学意义。结果共纳入32例患儿,34个拇指,年龄6个月至8岁,平均2.1岁;27个拇指伴桡侧多指,主、副拇指明确,均为主拇指(尺侧指)末节骨骺肥厚。术前拇指末节侧偏角度(35.6±13.2)°(15.0°~67.0°),最大被动屈曲范围(62.8±7.7)°(38.0°~80.0°),X线片中末节骨骺最大厚度(3.7±0.9)mm(2.3~5.9 mm)。所有患儿手术顺利完成,伤口愈合良好,无红肿、感染,患儿顺利出院。术后随访6~22个月,平均13个月,拇指末节偏斜角度(7.6±5.6)°(1.8°~13.4°),较术前显著减小,差异有统计学意义(t=10.36,P=0.012),其中,5个拇指术后残余尺侧偏斜,角度为(16.6±2.3)°(12.0°~20.0°),2例过矫正向桡侧偏斜15°、18°,其余患者拇指末节无明显尺偏;拇指末节被动屈曲最大角度为(62.9±7.5)°(35.0°~80.0°),与术前差异无统计学意义(t=0.16,P=0.359);X线片中拇指末节骨骺最大厚度为(1.9±0.5)mm(1.2~3.1 mm),较术前显著变薄,差异有统计学意义(t=17.04,P=0.012),骨骺均呈扁圆形,生长线均正常显示。结论采用精确定位的肥厚骨骺内楔形截骨,术后轻度过矫正固定,治疗儿童先天性拇指末节骨骺肥厚畸形可获得满意的偏斜矫正效果,显著缩短骨骺并改善其形态而不影响生长线,对关节屈曲活动无明显影响。
Objective To explore the clinical effect of precise intraepiphyseal wedge osteotomy for the treatment of congenital hypertrophic epiphysis of the distal phalanx of the thumbs in children.MethodsA retrospective analysis was conducted on the data of children with congenital hypertrophic epiphysis deformity of the distal phalanx of the thumb treated by precisely located intraepiphyseal wedge osteotomy in Dongguan Integrated Traditional Chinese and Western Medicine Hospital from January 2020 to January 2023.Preoperative X-ray films all showed asymmetric thickening of the secondary ossification centers,presenting as triangular,elliptical,unequal trapezoidal,and bipartite epiphyseal fusion shapes respectively.During the operation,precise localization was performed,and wedge osteotomy was conducted at 1.5 mm from the articular surface.The osteotomy angle and volume were adjusted according to the morphology of the hypertrophic epiphysis and the comprehensive condition of the distal and proximal phalanges,with axial over-correction of approximately 10°for fixation.Six months after surgery,the ulnar deviation angle of the distal phalanx with the interphalangeal joint of the thumb,the maximum passive flexion angle,and the thickness of the distal epiphyseal plate on X-ray were followed up.Statistical analysis was conducted using paired t-tests before and after surgery,and P<0.05 was considered statistically significant.ResultsA total of 32 children with 34 thumbs were included,aged from 6 months to 8 years old,with an average age of 2.1 years old.There were 27 thumbs accompanied by radial polydactyly,the main and accessory thumbs were clear,and the epiphysis of the distal phalanx of the main thumb was thickened.The lateral deviation angle of the distal phalanx of the thumb before surgery was(35.6±13.2)°(15.0°-67.0°),the maximum passive flexion range was(62.8±7.7)°(38.0°-80.0°),and the maximum thickness of the distal phalanx epiphysis in the X-ray was(3.7±0.9)mm(2.3-5.9 mm).All surgeries of all children were successfully completed,the wounds healed well without redness,swelling or infection.Patients were discharged smoothly.The average follow-up time after surgery was 13 month(rang from 6-22 months),with an average deviation angle of(7.6±5.6)°(1.8°-13.4°)in the distal phalanx with the interphalangeal joint,compared with before surgery,the difference was statistically significant(t=10.36,P=0.012).Five thumbs had residual ulnar deviation after surgery,with an average deviation of(16.6±2.3)°(12.0°-20.0°),two cases had corrected positive radial deviation(15°,18°),while the other cases had no significant ulnar deviation in the distal phalanx of the thumb.The average maximum angle of passive flexion of the distal thumb after surgery was(62.9±7.5)°(35.0°-80.0°),compared with before surgery,the difference was not statistically significant(t=0.16,P=0.359).The average maximum thickness of the distal epiphyses on postoperative X-rays was(1.9±0.5)mm(1.2-3.1 mm),compared with before surgery,the difference was statistically significant(t=17.04,P=0.012).The epiphyses were flat and round,and the growth lines were normal.ConclusionUsing precise intraepiphyseal wedge osteotomy,combined with postoperative fixation with mild overcorrection for the treatment of congenital hypertrophic epiphysis at distal phalanx of the thumb in children,can achieve satisfactory correction of deviation,significantly shorten and improve the morphology of the epiphysis without affecting the growth plate,and cause minimal impact on joint flexion activity.
作者
郭小明
田晓菲
于春波
Guo Xiaoming;Tian Xiaofei;Yu Chunbo(Department of Hand and Foot Surgery,Dongguan Integrated Traditional Chinese and Western Medicine Hospital,Dongguan 523800,China;Department of Plastic and Burn Surgery,Children’s Hospital of Chongqing Medical University,Chongqing 401122,China)
出处
《中华整形外科杂志》
北大核心
2025年第7期674-681,共8页
Chinese Journal of Plastic Surgery
关键词
拇指
骨骺内截骨
拇指偏斜
骨骺肥厚
Thumb
Intraepiphyseal wedge osteotomy
Deviated thumb
Hypertrophic epiphysis
