目的 探究示指背侧转位皮瓣治疗先天性拇指发育不良拇指撲挛缩的治疗效果.方法 2014年至2018年,在我院手外科就诊的27例(29指)拇指指撲挛缩患者,手术采取示指背侧转位皮瓣.以瘢痕情况、色素沉着、质地、厚度、屈伸畸形5个方面进行评价,分别赋值评分后得出总和,最高分为14分,其中0～2分为优,3～5分为良,6～8分为中,9～14分为差.结果 本组27例(29指)获得平均12个月的随访,转位皮瓣及示指背侧供区植皮均存活,其中优65.52％,良31.03％,可3.45％,差0％.结论 示指背侧转位皮瓣用于治疗Ⅱ型及Ⅲ型拇指发育不良的拇指撲狭窄手术操作简便,术后皮瓣质量好,外观满意,功能良好,是一种治疗拇指撲狭窄的良好手术方式.

目的 探讨Ollier病手部肿瘤的X线分类方法及治疗策略.方法 总结2002年至2017年我科收治的34例共358块短管状骨(掌骨117块,指骨241块)的X线表现,根据每一块骨中肿瘤的生长方式将其分类为:(1)内膨胀生长;(2)中心型膨胀生长;(3)偏心型膨胀生长;(4)混合型膨胀生长;(5)恶性变.分别统计术后患者肿瘤消失的块数及未消失的块数,计算肿瘤消失比例,对比不同分组间治疗效果差异.结果 本组34例中21例(172块短管状骨)获10～98个月随访,平均35.5个月.所有患者术后均未出现明显成骨不良导致的病理性骨折.内膨胀型组中有12块(80.0％)肿瘤消失,中心型膨胀组中有16块(34.8％)肿瘤消失,偏心型膨胀组中有23块(48.9％)肿瘤消失,混合型膨胀组中有6块(9.4％)肿瘤消失.Fisher精确检验结果显示,差异有统计学意义(P=0.000).两两比较显示,肿瘤消失情况在内膨胀组与中心型膨胀组(P=0.003)和混合型膨胀组(P=0.000)差异有统计学意义;在中心型膨胀组与混合型膨胀组差异有统计学意义(P=0.001);在偏心型膨胀组与混合型膨胀组差异有统计学意义(P=0.000).结论 本分类法体现了不同类型间骨骼受累严重程度及治疗效果预估的差异,同时将"内膨胀生长"这一症状不明显的类型以及"恶性变"这一应特殊考虑的类型加入其中,为本病的早期诊断和治疗提供了新的思路.建议采用皮质骨成形术治疗Ollier病的手部内生软骨瘤,不进行植骨术.

Objective To explore the classification and treatment efficacy of hand deformities of arthrogryposis multiplex congenita.Methods From January 2010 to January 2018,72 patients (144 thumbs,556 other fingers) with hand deformities of arthrogryposis multiplex congenita were treated.The patients were divided into 6 groups according to their different pathological and anatomical characteristics and treated accordingly.Results Postoperatively,60 patients (93 thumbs,296 other fingers) were follow-up for 1 to 83 months,with an average of 16.2 months.The overall excellent and good rate of the clinical efficacy of the affected fingers was 87.4％ (340/389),of which 76.3％ (71/93) was for the thumbs and 90.9％ (269/296) for the other fingers.All skin grafts survived and 1 finger recurred.Conclusion All the patients in this group have satisfactory finger movement and high safety after treatment.Therefore,according to the classification method described in this paper,the patients with hand deformities of arthrogryposis multiplex congenita can be treated accordingly,which can achieve good results.

Objective To discuss the thumb web anomalies with Poland's syndrome and the reconstruction strategies. Methods From June 2013 to July 2018, 46 cases of Poland's syndrome with the thumb web anomalies were classified into four conditons, linear contracture (14 cases), non-linear contracture (13cases), syndactyly (17 cases) and contracture with a empty first web (2 cases), which were reconstructed by Z plasty, direct incision with free skin grafting, syndactyly release and transfer flap from the dorsum of the index respectively. Results All the thumb webs were reconstructed with well blood supply. 84.7% cases were excellent or good after quality evaluation, and 10.9% for acceptable cases, 4.4% for unacceptable cases. Subjective functional accessment of the thumb showed 37 cases had significant improvement. Palmar abduction of 46 patients reached 45°. Conclusion Deformities of the thumb web for patients with Poland's syndrome needs early intervention, based on the classifications of the anomalies and the result is always good.

目的 探讨先天性扣拇畸形的分类,以及不同分类的治疗方法及治疗效果.方法 选用2010年1月至2018年1月我科诊治的113例(207个拇指)先天性扣拇畸形患者,将患者按不同的病理解剖特点分为6类,并按不同分类予以相应的治疗.结果 97例(150个拇指)获平均14.6个月的随访,优良率74.0％(111/150),且未发生植皮不成活、挛缩复发等不良并发症.结论 本分类法对于先天性扣拇畸形的治疗有指导意义,以此分类法进行的个体化治疗,临床疗效满意,有推广意义.

3D printing technology is a kind of rapid prototyping. With 3D-printers and associated computer programs, required 3D models could be built by plastics, nylon, metals et al. This recently developing technique is widely used in orthopedics and hand surgery fields. For example, a 3D-printed model has positive effect on fracture classification, preoperative planning and operation practicing. Intraoperative guidance based on 3D printing technology could guide the accurate placement of internal fixation, shorten the operation time, and improve the accuracy and safety of operation. Additionally, this rapid prototyping technique could be used in designing of internal/external fixation materials, clinical education, and bio-printing. In this review, we introduced the common types of 3D printing technology, gave a detailed description of SLA, FDM, and SLS techniques, summarized the application of this technique in orthopedics and hand surgery fields. In addition, deficiencies were summarized and prospects were analyzed briefly.