Congenital malformation refers to abnormal or potential abnormal factors at birth or before birth. Humans can have certain differences in anatomical structure, but generally it will not cause adverse consequences. If this abnormality has a certain influence on morphology and function, it is also a congenital malformation. So what?
Congenital hand deformity is a common disease, and its incidence rate is about 1‰ of that of newborns. Hand and upper limb deformities can occur alone, or they can be accompanied by multiple upper limb deformities at the same time, or they can be part of multiple syndromes. According to statistics, about 5% of congenital upper limb deformities are part of this syndrome.
Hand and upper limb malformations can also be accompanied by cardiovascular malformations, hematopoietic diseases, digestive tract malformations, facial malformations, brain malformations, genitourinary malformations and lower limb malformations.
The incidence of hand and upper limb deformity was 0.85‰. Due to the incomplete birth records of newborns in hospitals, the actual incidence rate is even higher than this. According to China's total population of 654.38+0.4 billion, the number of patients with hand congenital malformation is about100000, which is a figure worthy of attention.
Types of congenital malformation of hand
There are many kinds of congenital hand deformities, and it is a very complicated work to classify them. At present, the widely accepted classification system was revised by American Hand Surgery Association and International Hand Surgery Federation according to Swanson 1983 scheme. It combines the characteristics of embryology and anatomy, which is more systematic and detailed, but it still can't completely cover all malformations.
Common simple deformities are usually named according to the characteristics of deformities, such as polydactyly with redundant fingers, two or more fingers connected and inseparable syndactyly, and giant fingers with overgrown fingers.
I. Limb formation disorder
Congenital limb formation disorder, including complete or partial limb formation disorder, can be divided into horizontal type and vertical type.
1, hand transverse defect:
① Congenital absence of upper limbs; ② Congenital absence of wrist; ③ Congenital carpal bone loss; ④ Congenital absence of palm; ⑤ Congenital finger loss, the plane of finger loss can be located at the level of proximal, middle and distal fingers.
2. The longitudinal defects of the hand:
(1) The radial column is missing as a radial bat player; (2) Lack of foot column as a foot batter; (3) The stele lacks a splitting hand; (4) The longitudinal development of the center is blocked, and the middle section is longitudinally absent.
Second, limb differentiation disorder
This deformity is caused by finger separation disorder, which fuses between wrist joint and ordinary wrist bone, or between wrist bone and metacarpal bone. For interphalangeal joints, proximal interphalangeal joint fusion is more common, among which syndactyly is the most common.
1. Soft tissue involvement: multi-joint flexion, extensor digitorum longus, flexor digitorum longus, internal muscle, facial syndactyly, congenital finger flexion deformity, palm thumb deformity, non-bony finger deflection deformity, congenital trigger finger/thumb, wing armpit webbed elbow deformity, clubbed finger deformity, long nail deformity. ...
Etiology of congenital malformation of hand
So what is the cause of congenital malformation of the hand?
The etiology of congenital upper limb malformation is very complicated. At present, it can be summarized into two types: one is internal factors, that is, genetic factors, which are caused by chromosome abnormalities and gene mutations; The other is external factors, that is, environmental factors. Due to the influence of external factors, such as biology, nutrition, medicine, radiation, endocrine, trauma and other factors, deformity occurs in the embryonic period.
Most deformities are the result of the interaction of two factors, and environmental factors may have greater significance.
First, genetic factors.
Genetic factors include: ① chromosome abnormality, including chromosome number or structure abnormality. Because chromosome abnormalities often lead to abortion and stillbirth, there are few clinical cases. ② Gene mutation: 10% ~ 15% congenital malformation is caused by gene mutation, but most gene mutations do not cause congenital malformation.
Second, environmental factors.
That is, the deformity caused by external environmental factors during the embryonic period.
1. Biological factors: The mother suffers from some diseases in the early pregnancy, which may lead to fetal malformation.
2. Nutritional factors: Under normal circumstances, there are few opportunities for human mothers to lack nutrition, but maternal diabetes and some placental lesions may affect the nutritional supply of the fetus and affect embryo development.
3, drug factors: many drugs have teratogenic effects, such as thalidomide and other sedatives, most anticancer drugs, oral contraceptives and so on.
4. Radiation factor: Ionizing radiation is a strong teratogenic factor, which can lead to gene mutation and spread to the next or third generation. Some people irradiated mice before and after pregnancy with X-rays, and found that fetal mice had obvious growth inhibition, especially on the eyes and brain, as well as foot deformity, toe merging, limb amputation and polydactyly. ...
Treatment of congenital malformation of hand
Congenital malformation of hand is an unchangeable fact, but it can be adjusted. Let patients live a better life. Here is the treatment of congenital malformation of the hand for your reference ~
1, the treatment of hand deformity should focus on improving function, and then consider improving appearance. Some types of polydactyly and syndactyly can also be treated for the purpose of improving appearance.
2. Deformities that hinder development, such as compound syndactyly and facial soft tissue contracture, will gradually increase with limb development, and such deformities should be treated as soon as possible. Deformities that do not hinder development can be postponed to preschool treatment. Operations involving bone correction, especially those affecting bone development, are best performed after bone development has basically stopped.
3. Before orthopedic surgery, we should consider the expected functional effect of surgery and more structural blood vessels and nerves; Tendons, muscles, bones, joints and other dysplasia.
4. Consciously strengthening guidance and exercise after operation can make its function compensate and achieve good results.