{"nowTime30":1711703877674,"lyBarModerator":null,"metaSearch":{"description":"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","keywords":"专家向您解答 多指的发病率_洞医","title":"专家向您解答 多指的发病率_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。
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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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先天性多指、趾畸形是儿童发病率最高的先天性疾病,部分还会伴发心血管或泌尿等其它系统的畸形。多指多见于拇指的外侧和小指的内侧,其他手指较少累及。其中复拇畸形发病率最高,对手部外观及功能影响重大,其诊断和治疗是儿童骨科医生关注的重点。
先天性并指亦称蹼指,最常见第3、4指,拇指极少累及。最常见者,相邻两指仅软组织连接,偶尔有骨及关节连接。多见于双侧,有时并发足趾畸形,同时还有其他肢体异常。手在发育过程中,手指开始是并在一起的,再逐步分开形成一个拇指和四个手指。如果在此过程中,出现异常导致手指分开不彻底或没有分开,就会出现部分或完全并指。并指发生的确切原因尚不清楚,少数有遗传性,多数原因不明。
1.轴前型多指
(1)Ⅰ型和Ⅱ型对称型多指:将分叉的中央部分包括拇指的指甲、指骨连同软组织作均等楔形切除,剩余部分并拢缝合;不对称型多指:将偏斜于正常指、发育小的多指切除,但应注意重建指甲的外侧甲沟。
(2)Ⅲ型和Ⅳ型对称型多指:采用Ⅰ型和Ⅱ型对称型多指的治疗方法,也可将桡侧或尺侧的多指切除,摆正位置后克氏针内固定,但注意切除桡侧多指应移植拇短展肌,切除尺侧多指应移植拇内收肌,断指再植 畸形矫正 先天畸形不对称型多指:切除多指后做掌骨头楔形切骨,还要注意修复侧副韧带和鱼际肌止点的移植。
(3)Ⅴ型和Ⅵ型:通常切除发育最差的多指(如桡侧的多指,亦可是尺侧的多指)虎口狭窄可行“Z”形延长术,虎口扩大可行紧缩手术。
(4)Ⅶ型多指最常见的畸形是拇指分叉,切除多指后楔形切骨或克氏针内固定矫正畸形。
轴后型多指:Ⅰ型多指完全切除多指单纯缝合即可,对于Ⅱ型、Ⅲ型多指需确定和保护非常细小的外展肌腱和分叉骨膜外的尺侧副韧带、切除多余指、修整分叉处的多余骨、重建侧副韧带和外展肌腱。中央型多指:单纯的中央型多指应切除发育最差的指,修复、重建的原则同拇指和小指。远端指骨融合的畸形应在1岁内手术,使手的功能能较正常的发育,其余的畸形最好在5岁左右手术。如并指因发育不平衡出现畸形应提前手术,而没有功能的手指则可以在晚些时候施行手术。
找良医网温馨提示:如有身体不适,请及时就医!
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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