先天性奇形肢の血管系に関する臨床的実験的研究 : 2.先天性奇形手48例における血管系の検討

Accurate knowledge of the arterial variations of the congenitally malformed hand is of considerable practical importance not only in the process of reconstructive surgery in hand anomalies but also in the consideration of the time of teratogenic events. Between 1964 and 1982, angiography was performed on 48 malformed upper extremities of 41 patients at the Department of Orthopedic Surgery, Hiroshima University School of Medicine. The malformations were classified according to modified Swanson's categories, and the relationship between external and skeletal malformations and vascular abnormalities was studied. Radial ray deficiencies were often associated with hypoplasia or aplasia of the arteria (a.) radialis (12/15) and dysplastic arcus palmaris profundus (11/15). In cases of club hand and five-finger hand, persistence of the a. mediana was noted in a high frequency (8/10). Syndactyly (7 hands), brachysyndactyly (4 hands), Poland's syndrome (1 hand) and radial polydactyly (5 hands) were often associated with defective arcus palmaris superficialis (10/17). In cases of cleft hand (11 hands), vascular defects were rather inconspicuous. Cases of overgrowth (macrodactyly, 4 hands) showed almost normal vascular patterns. A patient with generalized skeletal abnormality (Apert's syndrome) had a defective arcus palmaris superficialis. Angiographic findings in these cases were compared with descriptions by others, and the time of teratogenic events was estimated from descriptions of human limb morphogenesis and results of animal experiments. The estimated teratogenic periods are as follows: radial ray deficiencies, postovulatory (po) day 38 or earlier; failure of differentiation of parts, undergrowth (brachysyndactyly and Poland's syndrome) and Apert's syndrome, po day 39 or earlier; cleft hand, po day 37 or earlier and duplication (radial polydactyly ), around po day 32