目的:拇指重复是最具挑战性的小儿重建手部手术之一。II型和IV型是最常见的,但也是最复杂的重建,因为重复出现在联合层面。消融和重建,最广泛使用的技术,旨在实现稳定,对齐良好,移动和美学上可接受的拇指。缺乏可靠的手术指南会导致手术效果欠佳的比率很高。这篇综述评估了文献中详细介绍的各种重建技术,并强调了预防常见继发性并发症的有用方法。
方法:进行了全面的PubMed和Embase文献检索。纳入标准为WasselII型和/或IV型,儿科患者,和初级或次级手术。排除标准是Bilhaut-Cloquet重建及其修改。技术进行了筛选,收集并分析以下继发性并发症:不稳定,轴向畸形,轮廓畸形。
结果:32篇文章符合纳入标准并进行综述。通过折叠收紧关节囊可以防止术后不稳定,掌板的推进,或使用骨膜瓣或双胸技术重建副韧带。关节成形术可以预防轴向畸形,剃掉掌骨头的三角形部分,偏心肌腱的集中化,使用长屈肌重建滑轮,或使用楔形或倾斜技术对指骨或掌骨进行矫正截骨术。第一次网络空间Z形成形术防止了有限的运动范围,通过计划的皮肤切口和软组织增强来解决软组织轮廓。术前,围手术期和术后注意事项,包括夹板,成像和固定,也有描述。
结论:尽管在拇指重复重建策略方面不断取得进展和知识丰富,很少有研究回顾和分析了各种报告的选择。这篇综述为医生和受训者提供手术计划指导,以预防常见的继发性并发症。进一步的研究应集中在标准化评估工具的开发上,能够对拇指重复重建进行可靠的前瞻性比较研究。
方法:IV.
Thumb duplication is one of the most challenging pediatric reconstructive hand surgeries. Wassel types II and IV are the most frequent, but also the most complex reconstructions as the duplication arises at the joint level. Ablation and reconstruction, the most widely used technique, aims at achieving a stable, well-aligned, mobile and esthetically acceptable thumb. The paucity of reliable surgical guidelines leads to high rates of suboptimal surgical outcomes. This review evaluated the various reconstruction techniques detailed in the literature and highlighted useful methods to prevent common secondary complications.
A comprehensive PubMed and Embase literature search was made. Inclusion criteria were Wassel type II and/or IV, pediatric patients, and primary or secondary surgeries. Exclusion criteria were Bilhaut-Cloquet reconstruction and its modifications. Techniques were screened, collected and analyzed for the following secondary complications: instability, axial deformity, and contour deformity.
Thirty-two articles met the inclusion criteria and were reviewed. Postoperative instability was prevented by tightening the joint capsule by plication, advancement of the volar plate, or reconstruction of the collateral ligaments using a periosteal flap or the double-breasting technique. Axial deformity was prevented by arthroplasty, shaving a triangular portion of the metacarpal head, centralization of eccentric tendons, pulley reconstruction using flexor pollicis longus, or corrective osteotomies of the phalangeal or metacarpal bones using the wedge or oblique techniques. Limited range of motion was prevented by first webspace Z-plasty, and soft-tissue contouring was addressed by planned skin incisions and soft-tissue augmentation. Preoperative, perioperative and postoperative considerations, including splinting, imaging and immobilization, were also described.
Despite the ongoing advances and abundant knowledge in reconstructive strategies for thumb duplication, there are few studies that reviewed and analyzed the various reported options. This review provides physicians and trainees with guidance in surgical planning to prevent common secondary complications. Further research should focus on the development of standardized assessment tools, enabling reliable prospective comparative studies on thumb duplication reconstruction.
IV.