併指畸形嬰兒之早期介入治療：病例報告

Early Intervention for a Baby with Syndactyly: A Case Report

楊奇旻(Chi-Min Yang) ； 楊書瑜(Shu-Yu Yang) ； 蔡瑜佩(Yu-Pei Tsai) ； 曾郁庭(Yu-Tin Tseng) ； 洪榮斌(Yu-Tin Tseng)

《台灣復健醫學雜誌》 43卷1期 (2015/03) Pp. 53-59

https://doi.org/10.6315/2015.43(1)06

摘要

併指（syndactyly）是一種常見的先天性異常，患者在相鄰手指間發生不正常的粘連狀況；又可依臨床表徵的嚴重程度分類為簡單型、複雜型、完全型、不完全型等等不同型態。併指臨床上多以手術治療，然而在術後復健治療介入卻少有相關文獻探討；本文提出一位嚴重十指完全併指的嬰兒，手術後接受早期復健治療介入，復健內容包括衛教照顧者手部疤痕之處理技巧，關節活動度運動，設計適當的副木擺位及教導誘發動作發展之技巧，將照顧者列入兒童治療團隊的一員，透過治療團隊共同的努力，可以減少術後併發症，並促進手部精細動作發展。本報告描述復健介入的內容及個案的功能進展狀況，並針對相關文獻做回顧與討論，以提供臨床醫療人員參考。

關鍵字

併指 ； 早期 ； 介入復健

並列摘要

Syndactyly is the most common congenital malformation of the limbs. Syndactyly refers to the clinical appearance of fingers or toes that have not undergone the normal process of separation and can be classified as simple, complex, complete or incomplete according to clinical severity and involvement. Clinically, syndactyly has primarily been treated with surgery. However, few studies have investigated relevant postsurgical rehabilitation interventions. This study reported a case involving an infant with severe syndactyly. After surgery, the infant received early rehabilitation intervention. We provided health education to caregivers to instruct them scar treatment on the hands, joint range of motion exercise, designed appropriate splint positioning, and skills to induce movement development. In addition, the caregivers were listed as members of a treatment team for the child. Because of the joint effort of the treatment team, the case experienced reduced postsurgical complications and improved development of delicate hand movements. This paper presents the rehabilitation intervention content and functional progression of the case as well as a relevant literature review and discussion. The results can serve as a reference for clinical medical staff.

並列關鍵字

syndactyly ； early intervention ； rehabilitation

參考文獻

De Smet L. Classification for congenital anomalies of the hand: the IFSSH classification and the JSSH modification. Genet Couns 2002;13:331–8.

Lumenta DB, Kitzinger HB, Beck H, et al. Long-term outcomes of web creep, scar quality, and function after simple syndactyly surgical treatment. J Hand Surg Am 2010;35(8):1323-9.

Goldfarb CA, Steffen JA, Stutz CM. Complex syndactyly: aesthetic and objective outcomes. J Hand Surg Am 2012;37:2068-73.

Schmelzer-Schmied N, Jung M, Ludwig K. Radiological and clinical outcome after operations in patients with congenital deficiencies of the wrist and hand. Eur J Radiol 2011;77:261-8.

Oda T, Pushman AG, Chung KC. Treatment of common congenital hand conditions. Plast Reconstr Surg 2010;126:121e-33e.