标题：改良Bilhaut-Cloquet术治疗婴幼儿复拇畸形疗效及对指甲外观的影响

      作者：刘耿，胡雷鸣，梁吉东，张红星    西安市红会医院手外科，陕西 西安 710000

      卷次： 2021年32卷23期

      【摘要】 目的 观察改良Bilhaut-Cloquet术治疗婴幼儿复拇畸形的疗效及对患儿指甲外观的影响。方法 回顾性分析2017年1月至2019年1月西安市红会医院手外科收治的105例复拇畸形婴幼儿的临床资料，根据治疗方法不同分为观察组 53例和对照组 52例，观察组给予改良Bilhaut-Cloquet术治疗，对照组给予传统Bilhaut-Cloquet术治疗，比较两组患儿的指关节活动范围评分、成角畸形评分、关节稳定性评分、近期临床疗效、指甲外观、并发症发生率及远期临床疗效。结果 治疗后，观察组患儿的指关节活动范围评分和成角畸形评分分别为(1.32±0.14)分、(1.43±0.28)分，明显低于对照组的(1.85±0.36)分和(1.95±0.40)分，关节稳定性评分为(1.01±0.12)分，明显高于对照组的(0.83±0.26)分，差异均有统计学意义(P<0.05)；治疗后，观察组患儿的指体宽大、指甲畸形发生率为0、13.21%，明显低于对照组的30.77%、94.62%，差异均有统计学意义(P<0.05)；观察组患儿的指体窄小发生率为30.19%，高于对照组的0，差异有统计学意义(P<0.05)；治疗后，两组患儿的近期临床疗效和并发症发生率比较差异均无统计学意义(P>0.05)；术后随访6~18个月，观察组患儿均Ⅰ期愈合，无皮肤及甲坏死，术后拇指形态良好，甲端无侧方畸形，指甲生长正常，指间关节和拇指与健侧一样活跃；对照组2例出现皮肤及指甲坏死发生，2例术后拇指继发畸形，3例指间关节活动度差。结论 改良Bilhaut-Cloquet术治疗婴幼儿复拇畸形疗效显著，可改善拇指外观和功能，但指体窄小发生率较高。
      【关键词】 复拇畸形；婴幼儿；改良Bilhaut-Cloquet术；疗效；指甲外观
      【中图分类号】 R722.19 【文献标识码】 A 【文章编号】 1003—6350（2021）23—3086—04

Curative effect of modified Bilhaut-Cloquet procedure in the treatment of infantile thumb duplication and itsinfluence on nail appearance.
LIU Geng, HU Lei-ming, LIANG Ji-dong, ZHANG Hong-xing. Department of HandSurgery, Xi'an Honghui Hospital, Xi'an 710000, Shaanxi, CHINA
【Abstract】 Objective To observe the curative effect of modified Bilhaut-Cloquet procedure in the treatment ofinfantile thumb duplication, and its influence on nail appearance of the infants. Methods The clinical data of 105 in-fants with thumb duplication, who admitted to Department of Hand Surgery, Xi'an Honghui Hospital from January 2017to January 2019, were retrospectively analyzed. The subjects were divided into an observation group (n=53) and a con-trol group (n=52) according to the treatment method. The observation group was treated with modified Bilhaut-Cloquetprocedure, and the control group was treated with traditional Bilhaut-Cloquet procedure. The scores of finger joint rangeof motion, angulation deformity and joint stability, short-term clinical effects, nail appearance, incidences of complica-tion and long-term clinical effects were compared between the two groups. Results After treatment, the range of mo-tion score and angulation deformity score of the observation group were (1.32 ± 0.14) points and (1.43 ± 0.28) points,which were significantly lower than corresponding (1.85±0.36) points and (1.95±0.40) points of the control group; thejoint stability score was (1.01±0.12) points, which was significantly higher than (0.83±0.26) points of the control group;and the differences were statistically significant (all P<0.05). The incidences of finger body leniency and fingernail defor-mity in observation group were 0 and 13.21%, which were significantly lower than corresponding 30.77% and 94.62%in the control group (P<0.05). The incidence of finger body stenosis in observation group was 30.19%, which was higherthan 0 in the control group (P<0.05); there was no significant difference in the recent clinical efficacy and good rate andthe incidence of complications between the two groups (P>0.05). At 6 to 18 months postoperative follow-up, all childrenin the observation group obtained primary healing, without skin or nail necrosis. The thumb appearance after operationwas good, and no lateral deformity was found at the distal segment. The nails grew normally, and interphalangeal jointactivities were the same as the contralateral thumb. In the control group, there were 2 cases of secondary skin and nail ne-crosis, 2 cases of secondary thumb deformities, and 3 cases of poor interphalangeal motion. Conclusion Modified Bil-haut-Cloquet procedure is markedly effective in the treatment of infantile thumb duplication, which can improve appear-ance and function of the thumb, with a low incidence of finger body stenosis.
      【Key words】 Thumb duplication; Infant; Modified Bilhaut-Cloquet procedure; Curative effect; Nail appearance