Objective: To investigate the effectiveness of double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique in treatment of thumb defect.
Methods: Between February 2017 and June 2019, 6 patients with traumatic thumb defects were treated with double osteotomy and lengthening of proximal phalanx and metacarpal by Ilizarov technique. There were 5 males and 1 female. The age ranged from 28 to 57 years, with an average of 41.5 years. There were 3 cases on the left side and 3 cases on the right side. All patients were admitted to the hospital in emergency department after injury, and the stump of the thumb was trimmed and sutured. The osteotomy plane was the distal part of the proximal phalanx in 4 cases and the interphalangeal joint in 2 cases. The interval between injury and osteotomy was 20-245 days (median, 34.5 days). After minimally invasive osteotomy and placement of a semi-circular external fixator, the lengthening began on the 5th day. The proximal phalanx and metacarpal were lengthened by 0.5 mm every day, once every 12 hours. The thumb of the affected side was distracted to the middle of the distal phalanx of the healthy thumb, and the fixator was removed after the bone healed.
Results: The distraction time was 14-23 days, with an average of 18.8 days. The osteotomies were healed with healing time of 91-147 days (mean, 120.2 days). The total distraction length of the proximal phalanx and metacarpal was 1.40-2.25 cm, with an average of 1.86 cm; healing index was 51.0-72.2 days/cm, with an average of 64.9 days/cm. All patients were followed up 5-12 months (mean, 8.2 months). At last follow-up, the two-point discrimination was 5.3-8.5 mm with an average of 6.98 mm. According to the evaluation standard of the upper limb part of the Chinese Medical Association, the score was 10-14, with an average of 12.5. Among them, 4 cases were excellent and 2 cases were good, with an excellent and good rate of 100%. All patients were satisfied with the function and appearance of thumb after operation. The Quick Disabilities of Arm, Shoulder, and Hand (Quick-DASH) score was 2.3-9.1, with an average of 6.1.
Conclusion: The double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique is an effective method for the treatment of thumb defects.
目的: 探讨采用 Ilizarov 技术行近节指骨与掌骨双截骨延长治疗拇指缺损的疗效。.
方法: 2017 年 2 月—2019 年 6 月收治 6 例（6 指）创伤性拇指缺损患者，均采用 Ilizarov 技术行近节指骨与掌骨双截骨延长。男 5 例，女 1 例；年龄 28～57 岁，平均 41.5 岁。左侧 3 例，右侧 3 例。伤后均急诊入院行拇指截指残端修整缝合术，截指平面分别为近节指骨远端 4 例、指骨间关节 2 例。受伤至该次延长术时间为 20～245 d，中位数 34.5 d。微创截骨并安置半环式外固定延长器，于术后第 5 天开始延长，近节指骨与掌骨每天同时分别延长 0.5 mm，每 12 小时延长 1 次。待拇指延长至健侧拇指远节指骨中段时停止，达骨愈合后拆除延长器。.
结果: 6 例患者延长时间 14～23 d，平均 18.8 d；截骨完全愈合时间 91～147 d，平均 120.2 d；近节指骨与掌骨总延长长度 1.40～2.25 cm，平均 1.86 cm；愈合指数 51.0～72.2 d/cm，平均 64.9 d/cm。患者均获随访，随访时间 5～12 个月，平均 8.2 个月。末次随访时，拇指两点辨别觉为 5.3～8.5 mm，平均 6.98 mm。根据中华医学会手外科学会上肢部分功能评定试用标准评分为 10～14 分，平均 12.5 分；其中优 4 例、良 2 例，优良率 100%。患者对手部功能和外观均满意，根据上肢功能评定表（Quick-DASH）评分为 2.3～9.1 分，平均 6.1 分。.
结论: 采用 Ilizarov 技术行近节指骨与掌骨双截骨延长是一种治疗拇指缺损的有效方法。.
Keywords: Ilizarov technique; Thumb defect; double osteotomy and lengthening; metacarpal; proximal phalanx.