摘要目的 以形态和轴线偏移情况为依据,对发生在末节的复拇畸形进行新的分类,以此对末节复拇畸形进行个体化治疗,并对手术效果进行评估.方法 回顾分析2003年4月至2012年12月收治的在指间关节以远分叉的复拇畸形共76例77指.以指体形态(指甲宽度和指体周径)和轴线偏移为指标进行综合分型,共分为5个类型:A型,非骨性连接型(漂浮拇);B型,主次轴线正常型;C型,主次轴线偏移型;D型,对称轴线正常型;E型,对称轴线偏移型.根据分型的不同采用不同的治疗方法:A型,次指单纯切除;B型,次指(绝大多数为桡侧指)切除+指间关节关节囊侧副韧带修复;C型,次指(绝大多数为桡侧指)切除+指间关节关节囊侧副韧带修复+近节指骨颈部截骨;D型,改良Bilhaut-Cloquet术+指间关节关节囊侧副韧带修复;E型,采用传统Bilhaut-Cloquet术,或者改良Bilhaut-Cloquet术+指间关节关节囊侧副韧带修复+近节指骨颈部截骨.手术效果以日本手外科学会多拇疗效评价表测评.结果 77指中A型3指,B型36指,C型13指,D型15指,E型10指.经6个月至5年随访,优66指,良9指,可2指.结论 新的分型方法能更全面地体现末节复拇畸形的临床特征,而且每种类型均可以采用可重复的基本术式进行个性化的治疗,效果令人满意.

abstractsObjective To study the classification and individualized treatment of the terminal phalanx of thumb duplication.Methods From Apr.2003 to Dec.2012,76 patients with 77 involved thumbs duplication at the level which is distal to the interphalangeal joint were retrospectively studied.Based on the morphology (the nail width and the thumb circumference) and the deviation of the thumb,we classified the terminal phalanx of thumb duplication into 5 types as Type A (no bony connection called floating thumb),Type B (asymmetry and no deviation),Type C (asymmetry and deviation),Type D (symmetry and no deviation) and Type E (symmetry and deviation).Different surgical procedures were selected according to different types.Simple excision of the smaller thumb was adopted for Type A case.Removement of the smaller thumb (usually the radial) and of the collateral ligament of the interphalangeal joint were selected for Type B.Removement of the smaller thumb (usually the radial) and reconstruction of the collateral ligament of the interphalangeal joint,as well as corrective osteotomies at the neck of the proximal phalanx were performed for Type C.The modified Bilhaut-Cloquet procedure with reconstruction of the collateral ligament of the interphalangeal joint were adopted in Type D.The classical Bilhaut-Cloquet procedure,or the modified Bilhaut-Cloquet procedure with reconstruction of the collateral ligament of the interphalangeal joint and corrective osteotomies at the neck of the proximal phalanx were performed in Type E.The results were assessed by an evaluation form for thumb duplication by the Japanese Society for Surgery of the Hand.Results According to our new classification standard,there were 3 cases with Type A duplicated thumbs,36 with Type B,13 with Type C,15 with Type D,10 with Type E.All the 76 patients underwent the individualized surgical treatment.The patients were followed up for 6-60 months.According to the evaluation form,excellent results were achieved in 66 thumbs,good in 9 thumbs and fair in 2 thumbs.Conclusions The new classification could comprehensively describe the clinical features of the terminal phalanx of congenital thumb duplication.Individualized therapy,including basic and repeated surgical procedure could be adopted for each type with satisfactory results.