{"nowTime30":1711699170555,"lyBarModerator":null,"metaSearch":{"description":"多指畸形男性高于女性,男女比例为3∶2,右手多于左手,比例为2∶1,双手发病约占10%,拇指多指发病率约占总数的90%以上。 治疗原则 两个拇指发育有差别则切除相对外观发育差,功能欠缺或三节指骨的拇指。如果两个拇指外观和功能差异不明显,常选择切除外侧多指。 多指发生于关节水平,除了多指切除,","keywords":"专家向您解答 多指畸形的治疗方法_洞医","title":"专家向您解答 多指畸形的治疗方法_洞医","channels":null},"identificate":{"id":"5a3adeaa985911e8972100163e0462f1","isDel":0,"createAt":1533437016805,"createBy":"8abb11d0af1511e7a3d800163e04584d","createName":"良药苦口","updateAt":0,"updateBy":null,"updateName":null,"userId":"8abb11d0af1511e7a3d800163e04584d","realName":"周鑫","certifiedStatus":2,"phone":"15525873223","email":"langlixunta@163.com","hospitalId":"14629","departmentId":"2035","illName":"","illId":"ac6f137def9411e7a3d800163e04584d","cardType":1,"cardImg":"http://01luntan.com/ly_img/1533437073284.jpg","idCardImg":"","identityType":2,"stop":0,"departmentName":"内分泌科","hospitalName":null},"canEdit":null,"adList":[],"lyBar":{"id":"1804","isDel":0,"createAt":1483430776066,"createBy":"system","createName":"system","updateAt":0,"updateBy":null,"updateName":null,"userId":null,"name":"先天性并指多指畸形","type":102,"twoCode":"http://zhao01.com/zly_img/zly_wx.jpg","image":null,"provinceId":null,"cityId":null,"illId":"45a55eb7badb11e6a61c00163e04584d","hospitalId":null,"keyWord":null,"totleTopic":0,"barDesc":null,"discussBarType":null,"metaSearch":"{\"channels\":{\"病友社区\":{\"description\":\"病友您提供:并指多指论坛_六指论坛_病友交流平台,让病友在便捷的求医路上不花一分冤枉钱。\",\"keywords\":\"并指多指论坛_六指论坛_病友交流平台\",\"title\":\"并指多指论坛_六指论坛_病友交流平台\"},\"治疗\":{\"description\":\"为您提供:婴儿六指切除最佳时间_六指畸形手术最佳时间等相关信息,让病友在便捷的求医路上不花一分冤枉钱。\",\"keywords\":\"婴儿六指切除最佳时间_六指畸形手术最佳时间\",\"title\":\"婴儿六指切除最佳时间_六指畸形手术最佳时间\"},\"症状\":{\"description\":\"为您提供:新生儿大拇指并指_新生儿六个手指头等相关信息,让病友在便捷的求医路上不花一分冤枉钱。\",\"keywords\":\"新生儿大拇指并指_新生儿六个手指头\",\"title\":\"新生儿大拇指并指_新生儿六个手指头\"},\"并发症\":{\"description\":\"为您提供:婴儿六指会影响智力吗_婴儿六指会有什么影响等相关信息,让病友在便捷的求医路上不花一分冤枉钱。\",\"keywords\":\"婴儿六指会影响智力吗_婴儿六指会有什么影响\",\"title\":\"婴儿六指会影响智力吗_婴儿六指会有什么影响\"},\"饮食\":{\"description\":\"为您提供:六指手术后不能吃什么?_六指手术吃什么好等相关信息,让病友在便捷的求医路上不花一分冤枉钱。\",\"keywords\":\"六指手术后不能吃什么?_六指手术吃什么好\",\"title\":\"六指手术后不能吃什么?_六指手术吃什么好\"},\"病因\":{\"description\":\"为您提供:宝宝并指多指整形_婴儿六指是什么原因等相关信息,让病友在便捷的求医路上不花一分冤枉钱。\",\"keywords\":\"宝宝并指多指整形_婴儿六指是什么原因\",\"title\":\"宝宝并指多指整形_婴儿六指是什么原因\"},\"病友求助\":{\"description\":\"为您提供:宝宝六个手指怎么回事_婴儿六个手指怎么回事等相关信息,让病友在便捷的求医路上不花一分冤枉钱。\",\"keywords\":\"宝宝六个手指怎么回事_婴儿六个手指怎么回事\",\"title\":\"宝宝六个手指怎么回事_婴儿六个手指怎么回事\"},\"预防\":{\"description\":\"为您提供:六指怎么形成的_六指会遗传吗等相关信息,让病友在便捷的求医路上不花一分冤枉钱。\",\"keywords\":\"六指怎么形成的_六指会遗传吗\",\"title\":\"六指怎么形成的_六指会遗传吗\"}},\"description\":\"为您提供:六指婴儿_六指症手术_六指手术风险大吗_儿童并指畸形、病友的治疗经验等相关信息,让病友在便捷的求医路上不花一分冤枉钱。\",\"keywords\":\"六指婴儿_六指症手术_六指手术风险大吗_儿童并指畸形\",\"title\":\"六指婴儿_六指症手术_六指手术风险大吗_儿童并指畸形\"}","adInfo":null},"isLikeThisTopic":null,"lastTopics":[{"id":"7218","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"专家向您解答 多指会引起其他疾病吗","content":"
多指症的并发症主要有五个方面:
① 成角畸形:由于多指切除后瘢痕挛缩,牵拉拇指末节向一侧偏斜,以致指间关节不平,形成一定角度的弯曲,拇指无法伸直。
② 指间关节不稳:术后拇指的指间关节只能作屈伸动作,不能左右摆动,因而会出现捏物无力、握笔不稳。这是切除多指时没有修复侧副韧带的缘故。
③ 骨赘形成:多指切除时患儿年龄偏小,手术中不能充分切除多指的指骨,留下一个残端,或者切除多指时残留的骨膜逐渐骨化,随着年龄的增长,又形成了一个“复发性多指”。
④ 外观细小:如果对“孪生拇指”,只是简单地切除一个指,留下的拇指必然较对侧细小,外形很不美观。
⑤ “Z”字畸形:主要是对复杂型的多指进行切除时,忽略了一些精细的“工序”,以致手术后,指间关节偏斜,形如“Z”字畸形。这是多指切除后最复杂的一种畸形。
","barId":"1804","topicTypeId":null,"topicThemeId":"1029","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":4},{"id":"7219","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"专家向您解答 多指治疗方法有哪些","content":"多指的手术治疗不仅要有明显的美容效果,更重要的是重建手部功能。多指的手术切除并不困难,但需根据多生手指的外形、位置、结构以及和正常手指的关系,结合X线检查进行全面的考虑,决定多生手指切除的部位和方式。单纯性多指做多指切除及局部皮肤整形;复合性多指除了多指切除以外,还需进行多余的掌骨全切除或部分切除。掌骨切除的多少需根据患手的形态与功能重建的要求确定。在切除多指的同时,有时需进行关节、骨骼畸形矫正、关节韧带修复及皮肤整形等。
手术时机:对仅以狭长的皮蒂与正常手指相连的赘生指,简单切除即可,出生后即可进行;对简单型多指,特别是尺侧多指,出生后3~6个月手术较好;对有严重畸形、组织缺损的复杂多指,可借助显微外科技术,在1岁后行多指切除,进行组织移植或移位等手术重建功能,并定期复查直至发育停止期。掌、指骨截骨矫形应在1岁以后;对掌功能重建应在3岁以后为妥,多宜行掌长肌腱移位。
各类多指手术注意事项:
拇指多指的解剖变异较大,其治疗往往比想像的复杂得多,简单的切除往往带来畸形、关节不稳定与功能障碍,因此应根据不同情况来决定手术方案。原则上保留外观较正常、功能较好的拇指。拟切除的多指如有主要神经血管束时,应仔细分离,切勿损伤,予以保留;如有主要肌腱或内在肌止点时,也应移位到保留拇指的相应位置。对位于掌指或指间关节囊内的多指切除时,应保留多指的关节囊及韧带组织,用来修复拇指关节囊,维持关节稳定性。当保留的拇指过于偏斜时,尚需在骨骺发育基本停止后进行关节融合或截骨矫形术。
拇指末节分叉畸形,虽对功能影响不大,但有碍美观,从改进外观出发,可将并连拇指中间的骨骼及皮肤、指甲楔形切除后,将保留的两侧直接缝合形成拇指。若末节并连拇指偏一侧且较小,可将其切除后,用掌侧皮瓣覆盖缺损并内翻缝合重建甲沟。
多指骨拇指畸形,可通过手指拇指化手术进行矫正。单独发生的拇指或小指三角形指骨畸形,其功能损害较小,患者中较多的是要求改善外形而就诊。Wood(1977)对三角形指骨作中央截骨,然后进行楔状植骨矫正畸形。还可采用反向楔形截骨植骨术,即将三角形指骨在其界面长的一侧作楔形截骨,移植到界面短的一侧,以矫正手指的成角畸形。
小指尺侧的多指切除一般不涉及关节囊、肌腱的修复,当有多生掌骨时应一并切除。
中央多指切除时,由于常伴有并指畸形,血管、神经变异屡有发生,切除时应避免损害存留指的血供与神经支配,以防存留指坏死,必要时可分次手术切除。
近节指骨型多指切除时,手术重点是矫形和功能重建。应注意保留附着在多生指上的关节囊和侧副韧带,在切除多生指后,将手内在肌牢固地缝合在保留指近节基底部,重新修复关节囊和韧带,以保持指关节的稳定性。多指切除时,指伸屈肌腱可保留,以加强保留指的伸屈功能,或用于重建侧副韧带。在保留指伸屈肌腱先天性缺损时,可在切除多指的同时,行示指伸指肌腱和环指指浅屈肌腱移位,重建保留指的功能。
如果夫妻一方或双方有多指并指家族遗传史,其子代由遗传因素作用引起的发病数占总发病数的90.18%,近年来通过进行分子生物学的研究,目前已经定位了4个多指畸形基因位。
在新生儿中的发生率约为0.30‰—1.90‰。
每500个小孩就会有1个出现多指症。非洲裔黑人小孩会较多患上轴后多指症,黑人男孩出现轴后多指症差不多是白人的10倍。一项研究发现每1000个白人男性中,就有2.3个患上多指症,而1000个白人女性中,则有0.6个患上;1000个黑人男性中,有13.5个会患有此病,1000个黑人女性中,则有11.1个患上。
多指症男性高于女性,男女比例为3∶2右手多于左手,比例为2∶1,双手发病约占10%拇指多指发病率约占总数的90%以上。
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多指畸形男性高于女性,男女比例为3∶2,右手多于左手,比例为2∶1,双手发病约占10%,拇指多指发病率约占总数的90%以上。
治疗原则
两个拇指发育有差别则切除相对外观发育差,功能欠缺或三节指骨的拇指。如果两个拇指外观和功能差异不明显,常选择切除外侧多指。
多指发生于关节水平,除了多指切除,还要切除并且阻滞部分对应近侧关节软骨面,有效防止多指复发,并且修补关节囊、侧副韧带,转移缝合肌腱。
复拇发生于骨干水平合并成角畸形,多指切除的同时截骨矫形纠正力线,指骨钢针内固定。对于发育差、畸形严重(蟹钳状)的复拇畸形,早期(8-12月)行改良的Bilhaut手术,以软组织的合并取代骨骼的合并以降低骨不连、关节强直等并发症,同时通过肌腱转移,凸侧软组织缩窄等方法矫形,最大程度重塑一个美观而功能完善的拇指。对于残留畸形可以通过配戴矫形支具等方法进一步纠正,或等患儿3-6岁进一步行骨性手术纠治。
多趾畸形一般建议在学步前即生后9-12月手术治疗,否则走路后再治疗,足底已经形成异常受力部位,手术后该受力部位被切除或改变,从而影响步态。
手术治疗
发现疾患后及时就医,医患沟通后根据病情制定合理的个性化的治疗方案。
先天性多指、趾畸形的治疗根据疾病程度的不同而异,简单的皮赘型多指、趾可在生后1月手术切除,如考虑麻醉的安全性,也可推迟至生后3月。
对于复杂的包含有关节骨骼连接的多指,可在6月-3岁手术切除,手术之前须评价多指、趾重复水平,进行分型;还要评价每一部分的发育程度、关节的稳定性和活动度、骨骼轴线的偏离程度及手指畸形的严重程度
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