摘要
目的比较掌背推进皮瓣与传统皮瓣联合植皮技术治疗单纯性完全并指的手术疗效。方法回顾性分析2017年4月至2023年6月广州医科大学附属妇女儿童医疗中心收治的40例单纯性完全并指患儿的临床资料,40例患儿共51指蹼出现并指;其中男33例(41指蹼),女7例(10指蹼);畸形位于左手29指蹼,位于右手22指蹼;患儿的手术年龄为(23.9±10.3)个月,范围为5~64个月;手术中24指蹼接受植皮,27指蹼未植皮。根据术中采用的皮瓣形状将51指蹼分为两组,掌背推进皮瓣(包括五边形或双翼皮瓣)为A组(33指蹼),三角形或矩形皮瓣为B组(18指蹼),比较两组的一般资料和术中植皮比例。所有患儿术后随访(36.7±21.5)个月,范围为7~80个月,末次随访采用Withey评分(分为瘢痕质量、屈伸活动、指蹼爬移、侧弯畸形、旋转畸形5个方面)评估患儿并指矫正的效果。组间比较采用独立样本t检验或χ2检验。结果两组病例在性别、畸形侧别、指蹼部位、并连皮肤紧张程度以及手术年龄、随访时间上差异均无统计学意义(均P>0.05)。A组的植皮率为30.3%(10/33),低于B组的77.8%(14/18),差异有统计学意义(χ^(2)=10.537,P=0.001)。末次随访时,A组的Withey评分总分为(3.12±1.92)分,B组总分为(4.17±2.01)分,差异无统计学意义(t=–1.83,P=0.073)。A组的瘢痕质量评分为(2.06±0.83)分,低于B组的(2.61±0.70)分,差异有统计学意义(t=–2.40,P=0.020);屈伸活动、指蹼爬移和手指侧弯、旋转畸形评分两组差异无统计学意义(均P>0.05)。结论与三角形、矩形皮瓣联合植皮技术的传统术式相比,采用五边形、双翼皮瓣的掌背推进皮瓣治疗单纯性完全并指能有效避免植皮,术后瘢痕更美观,且两者在预防指蹼爬移、手指屈伸活动、侧弯及旋转畸形方面效果相当。
Objective To compare the surgical effect of skin grafting versus a dorsal metacarpal advancement flap in simple complete syndactyly.Methods Clinical data of 40 children with simple complete syndactyly(51 web spaces)treated in the Guangzhou Women and Children's Medical Center from April 2017 to June 2023 were retrospectively analyzed.Among them,there were 33 boys(41 webs)and 7 girls(10 webs).Twenty‑nine webs were on the left hand and 22 webs were on the right hand.The surgical age of the patients was 23.9±10.3 months,ranging from 5 to 64 months.During the operation,skin grafts were performed on 24 webs,while those on 27 webs were not.Based on the use of flaps,patients were divided into group A(two wing‑shaped and pentagonal flaps,33 webs),and group B(triangular and rectangular flaps,18 webs).The general data and the proportion of skin grafting of the two groups were compared.All children were followed up for 36.7±21.5(7‑80)months.At the last follow‑up,the Withey score was graded for assessing syndactyly release,involving the parameters of scar quality,flexion‑extension deformity,web creep,lateral flexion deformity,and rotation deformity.Intragroup comparisons were performed using independent sample t‑test or Chi‑square test.Results There were no significant differences in the gender,affected side,web type,skin tension,operative age,and follow‑up duration between groups(all P>0.05).The skin grafting rate in group A was significantly lower than that of group B[30.3%(10/33)vs 77.8%(14/18),χ^(2)=10.537,P=0.001].At the last follow‑up,the total Withey score was comparable between group A and group B[(3.12±1.92)points vs(4.17±2.01)points,t=–1.83,P=0.073].The score of scar quality was significantly lower in group A than that of group B[(2.06±0.83)points vs(2.61±0.70)points,t=–2.40,P=0.020].There were no significant differences in the scores of flexion‑extension deformity,web creep,lateral flexion deformity,or rotation deformity between the two groups(all P>0.05).Conclusions Dorsal metacarpal advancement flaps(two wing‑shaped and pentagonal flaps)significantly reduce the need for skin grafting and improve scar aesthetics compared to conventional triangular and rectangular flaps,while demonstrating equivalent efficacy in preventing finger web crawling,finger flexion and extension,scoliosis,and rotational deformities.
作者
林鸿鸿
吴剑平
李敬春
黎艺强
刘远忠
徐宏文
Lin Honghong;Wu Jianping;Li Jingchun;Li Yiqiang;Liu Yuanzhong;Xu Hongwen(Department of Orthopaedics,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou 510623,China)
出处
《中华小儿外科杂志》
北大核心
2025年第7期638-643,共6页
Chinese Journal of Pediatric Surgery
基金
广州市卫生健康科技项目(20231A011039)。
关键词
并指
皮瓣
植皮术
Syndactyly
Flap
Skin grafting
