| Objective: To To explore the application effect of anchor technique in the reconstruction of orthopaedic function of thumb duplication.Thumb duplication,also known as complex thumb malformation,is the most common congenital malformation of the hand.It is manifested as thumb duplication with abundant anatomical morphological variation,and its incidence is 0.008% ~ 0.018%.According to the classical theory,ectoderm and preaxial mesoderm necrosis were interfered before 8 weeks of embryo,which was the cause of thumb duplication.The diagnosis was not complicated,and it could be diagnosed and classified by shape and hand X-ray.There are many classification methods for thumb duplication,and the most classic and universal classification method is still Wassel classification,whose treatment is mainly surgery,with the purpose of improving the appearance and function of the thumb and alleviating children’s inferiority and other psychological problems.Correction of thumb duplication involves many deformed tissues,including the metacarpal bone,joint capsule,ligament,muscle and tendon,etc.,which may cause joint deviation,weak extensor force and joint instability,etc.,often requiring multiple tissue function reconstruction.For the ideal orthopaedic surgery for thumb duplication,it is necessary to fully confirm the pathological anatomy and X-ray morphological characteristics.Traditional surgery to improve appearance from initial pure to the later corresponding functional reconstruction of thumb has experienced a long and complex process,a myriad of postoperative follow-up to make our cognition to repeat the obstacle of the thumb deformities is first appearance,did not get a recurrence after repair or repair deformity children in daily life formed low self-esteem and other psychological problems is very serious,may accompany the life;Followed by the function barrier,the hand is the most important organ,people use the tools and the thumb and 40% to 50% of the total of hand function,repeat the thumb duplication itself with structural abnormalities caused by the dysfunction and the imperfect of the operation will lead to the dysfunction of the trouble of life of patients with,for the first time caused by imperfect surgery to repair the sequela and subsequent repeated repair surgery will also bring endless pain to the patient and the heavy economic pressure.The purpose of this study is to apply the anchor technique in the repair surgery.Through one operation to repair the appearance of the deformed thumb and reconstruct the thumb function,avoid the psychological problems of the children and maintain the integrity and fluency of the hand function.Methods:Select the Third Hospital of Hebei medical university in September 2016 to December 2018 cases treated by complex thumb deformities,15 cases with fat removal,retain bone cutting orthopaedic,ground anchor joint lateral collateral ligament,joint capsule check point reconstruction,thumb short abductor muscle,hallux flexor muscle and thumb long stretch muscle reconstruction method such as orthopaedic check point,postoperative gram fixed needle for a month,after using external fixation support intermittent orthopaedic,set it to anchor group;A total of 15 cases of children admitted to our department of the Third Hospital of Hebei medical university from March 2016 to August 2016 due to thumb duplication and underwent surgery were selected for postoperative follow-up.As the enrolled patients used traditional surgical methods and did not use anchor technique,they could become the control group and be set as the traditional group.At 1,6 and 12 months after the operation,the patients’ hand functions were scored,and the evaluation criteria of thumb function were adopted by the hand surgery branch of Chinese medical association.The measured data were analyzed by SPSS13.0 statistical software.Measurement data with x? + s,comparison between groups using analysis of variance and t test,measurement data by chi-square test,significant levels of α = 0.05.Results: No family history of complex thumb malformation was found in the patients followed up in this study.The postoperative follow-up time was 1,6 and 12 months,respectively.After 12 months,the metacarpophalangeal joint stability of all the children in the anchor group was good,Lateral pull test(-),measuring the thumb joint range of motion,including buckling,straighten,thumb function of outreach,thumb pinch strength(the index finger pinch strength of the thumb,expressed as a percentage of the contralateral pinch strength)measured 15 thumb joint flexion maximum average of 44.6°,the maximum average 45.1°back stretch;The thumb radial maximum average 43.7°lateral outreach;The thumb volar outreach maximum average of 43.8°.Good stability of thumb joint and abduction of thumb can be obtained after operation The stability of the metacarpophalangeal joint in the traditional group was satisfactory 12 months after surgery,lateral pull test(-)in 3 cases.lateral pull test(+)for other children.Measuring the thumb joint range of motion,including buckling,straighten,thumb function of outreach,thumb pinch strength(the index finger pinch strength of the thumb,expressed as a percentage of the contralateral pinch strength)measured 15 maximum average 39.5°,the thumb joint flexion and maximum average of 40.4 °back;The thumb radial maximum average up to 39°lateral outreach;The maximum average up to 38.3 ° thumb volar outreach.Conclusion: For thumb duplication orthopaedic function reconstruction,the first is to solve the obstacle of the shape,followed by function barrier,the postoperative secondary deformities often because reserve refers to the epiphyseal morphological development,an abnormal tendon strength pull and dense bone residue,such as most with surgery,either early or late poor bone cutting Angle,tendon check point reconstruction,fixed length,postoperative function exercise time and intensity and so on.Traditional surgical methods can take into account most factors that affect the prognosis,but there is still a significant shortage compared with the use of absorbable anchorage.Using absorbable anchors,in the process of operation can be simplified joint capsule and the muscle tendon reconstruction process,reduce the soft tissue around the incision,postoperative scar tissue area,flexible selection of rebuilding the check point location,more conducive to achieve soft tissue balance,increase the lateral stability,prevent the happening of the secondary deflection,and can absorb anchors can shorten the postoperative external fixation time,prompting patients implementation of limb function recovery exercise as soon as possible,and high stability,anchor nails fixed firmly,good tendon check points close connection,tendon and bone is more conform to the requirements of the biological mechanics,good treatment effect. |
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