| Objective:To retrospectively analyze the diagnosis and treatment of thumb polydactyly patients,pathogenesis characteristics,clinical classification,surgical methods,and postoperative outcomes.Methods:The clinical data of 401 patients with thumb polydactyly were collected,including age,gender,family genetic history,diagnosis,classification,specialist physical examination,auxiliary examination,operation time,surgical methods,etc.We retrospectively analyzed the diagnosis,disease characteristics,clinical classification,surgical methods and postoperative effects.SPSS 23.0 software was used for statistical data analysis.Results:There were 401 cases（428 fingers）in this group,including 374 cases of unilateral thumb polydactyly,accounting for 93.3%,and 27 cases of bilateral thumb polydactyly,accounting for 6.7%.There were 250 male patients,accounting for 62.3%,and 151 female patients,accounting for 37.7%.The ratio of male to female was about 1.7:1.15 patients had a family history of the disease,accounting for 3.7%,which including 6 male patients,accounting for1.5%,and 9 female patients,accounting for 2.2%.According to Wassel classification: Type I was observed in 1.6%（7/428）of the fingers,type II in16.8%（72/428）of the fingers,type III in 8.9%（38/428）of the fingers,type IV in 41.8%（179/428）of the fingers,type V in 7.9%（34/428）of the fingers,type VI in 4.7%（20/428）of the fingers,type VII in 4.2%（18/428）of the fingers,and floating thumb in 14.0%（60/428）of the fingers.175 fingers of left thumb polydactyly were observed,accounting for 40.9%,and 253 fingers of right thumb polydactyly were observed,accounting for 59.1%.The ratio of left and right was about 1:1.4.The operation time ranged from 28 days to 33 years old after birth,with an average of 16.5 years old.Patients were grouped according to the age when they received surgery,there were 133 patients between 0 and 6months,accounting for 33.2%,242 patients between 6 months and 2 years old,accounting for 60.4%,11 patients between 2 and 3 years old,accounting for2.7%,and 15 patients over 3 years old,accounting for 3.7%.Most of them completed the operation within 2 years old.The patients in this group were followed up after operation.A total of 229 patients were followed up.The follow-up time ranged from 14 months to 96 months after operation,with an average of 55 months.The follow-up contents included joint range of motion,joint stability,finger alignment,etc.And the Kawabata score was applied.The postoperative function was evaluated,and the results were excellent in 170cases（accounting for 74.2%）,good in 53 cases（accounting for 23.1%）,and poor in 6 cases（accounting for 2.6%）.Among them,53 patients developed secondary deformity or dysfunction after operation,and10 patients completed secondary operation in our hospital,accounting for 4.4%.There are 34 fingers of type II thumb polydactyly,and 2 fingers of them underwent secondary operation,accounting for 5.9%;106 fingers of type IV,and 5 fingers of them underwent secondary surgery,accounting for 4.7%;10fingers of type VI,and 1 finger of them underwent surgical treatment,accounting for 10.0%;8 fingers of type VII,and 3 fingers of them underwent surgical treatment,accounting for 37.5%.The functional evaluation was performed at the second postoperative follow-up: including excellent（2 cases）,good（7 cases）,and poor（1 case）.Conclusion:Polydactyly of the thumb is the most common congenital malformation,and the incidence is increasing year by year.The cases with genetic history tend to be few,and sporadic cases are more common.Thumb polydactyly should be treated by operation.According to the type of thumb,the proper operation method should be selected,and the tissue structure of redundant fingers can be used to repair and reconstruct the good shape and flexible function of the thumb,so as to avoid the second operation.The timing of surgery should be determined according to the child’s physiological anatomical developmental stage and social and psychological factors.Whether or not to perform a second operation depends on whether the first surgical treatment is complete.The timing of the operation,the choice of the surgical method,the doctor’s experience and the recovery after the operation are related to it.A standardized treatment should be strictly formed,and the training of a specialist and the selection of the timing of the operation should be carried out to formulate relevant guidelines on the precision of surgical methods. |
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