目的:分析伴有2个重复n 趾并连以及主n 趾内翻畸形的轴前型多趾的解剖特点，并探讨相应的手术整复方案及其效果。n 方法:收集2010年1月至2020年1月重庆医科大学附属儿童医院烧伤整形外科收治的一类特殊轴前型多趾病例资料，患者表现为重复的n 趾皮肤并连，有主、副n 趾之分，胫侧n 趾发育不良，腓侧为主n 趾但均伴明显的内翻畸形。分析此类畸形的解剖特点、手术切口设计、骨关节矫正方式并随访术后n 趾轴向以及对行走功能的影响。n 结果:共纳入该类轴前型多趾患儿10例(12个n 趾)，其中男6例，女4例；年龄5~45个月，平均19.3个月；单侧8例，双侧2例。所有病例均为重复n 趾完全并连、胫侧趾发育不良且向近端移位，腓侧趾为主n 趾但不同程度内翻(内翻角度25°~90°，平均55°)。术中见n 趾外展肌止点附着于胫侧趾，连带并连的主n 趾跖趾关节向内侧脱位，并伴有跖趾关节面的倾斜。手术切口设计：3趾内翻角度25°~40°，采用环绕多趾的齿状切口；3趾内翻角度45°~90°，采用多趾近端蒂皮瓣切口；6趾内翻角度75°~90°，采用双Z成形切口。骨关节矫正方式：多趾切除后，2趾的轻度内翻在经松解主n 趾胫侧挛缩软组织、n 趾关节复位后，轴向获得矫正；其余10趾行跖骨或趾骨胫侧撑开式截骨后，轴向获得矫正，其中9趾骨缺损行楔形植骨。创面闭合方式：全部患趾的手术创面均顺利关闭，其中采用多趾近端蒂皮瓣转移的3趾中有2趾因皮肤不足，行植皮补充；采用双Z成形切口的6趾，虽然内翻角度大，但经延长胫侧纵向皮肤后均能完全关闭创面。术后2例失访，其余8例(10趾)随访5~38个月(平均13个月)，除1趾内翻矫正不足(内翻15°)，2趾矫枉过正(外翻15°、20°)，其余n 趾轴向正常；所有病例穿鞋行走正常。n 结论:趾外展肌止于发育不良的胫侧趾，连带并连的主n 趾跖趾关节向内侧脱位导致内翻，并伴有跖趾关节面的倾斜是这类轴前型多趾的解剖特点。主n 趾的内翻畸形以及矫正内翻后胫侧皮肤的不足是其手术难点。术中松解外展肌止点并行撑开式截骨可获得良好的轴向矫正，采用双Z成形切口能充分延长胫侧纵向皮肤，可一期关闭创面，无需植皮。n “,”Objective:To analyze and report the anatomical characteristics, surgical management and clinical outcome for preaxial polysyndactyly with varus deformity.Methods:We retrospectively reviewed our database of cases with preaxial polysyndactyly in the Department of Burn and Plastic Surgery of Children’s Hospital of Chongqing Medical University from January 2010 to January 2020. The clinical manifestations are duplicated hallux, with complete fusion of the main and auxiliary hallux, tibial hallux dysplasia, and fibular hallux with obvious varus deformity. The anatomical characteristics of this special polysyndactyly, surgical incision design, osteoarticular correction methods were analyzed, and the axial line of the big toe after the operation and its influence on the walking function were followed up.Results:A total of 10 children with preaxial polysyndactyly (12 toes) were enrolled, including 6 male and 4 female patients. Age ranged from 5 to 45 months, with an average of 19.3 months. Eight cases were unilateral, and 2 cases were bilateral. All the cases had duplicated hallux, with tibial hallux dysplasia and proximal displacement. The fibular hallux was dominant but with varus deformity to varying degrees (varus angle 25°-90°, mean 55°). During the operation, the abductor hallucis (AbdH) was found to be attached to the tibial hallux, and the metatarsophalangeal (MTP) joint of the dominant hallux was dislocated to the tibial side, with an inclination of the joint surface. Incision design: zigzag incision around extra toes were used in 3 toes with varus angle from 25° -40°, proximal pedicle flap of the extra toe was taking in 3 toes with varus angle from 45°-90°, and double Z-plasty incision was designed in 6 toes which varus angle is from 75°-90°. Correction of bone and joint: after extra toe resected, the axis of two cases with mild hallux varus was corrected by releasing the soft tissue contracture in the tibial side of the main toe and reducing the joint. The other 10 cases were obtained completely axially corrected after opening osteotomy performed at the tibial side of the metatarsal bone or phalanx, and nine of them were treated with bone graft for filling the bone defect. Wound closure: all wounds were successfully closed. Among these, 2 of the 3 toes that taking transferred proximal pedicle flap of extra toe were supplemented with skin grafts due to skin deficiency. Although the varus angle was large, the wounds of 6 toes with double Z-plasty incision were completely closed after lengthened the longitudinal skin of the tibial side of the big toe. Two cases were lost to follow-up, and the other 8 cases (10 toes) were followed up for 5-38 months (mean 13 months). Except for 1 toe with insufficient correction (hallux varus 15°) and 2 toes with overcorrection (hallux valgus 15°, 20°), the axial lines of the other big toes were normal. All cases wore shoes and walked normally.Conclusions:The anatomical characteristics of this type of preaxial polysyndactyly are the AbdH terminating in the deformed tibial toe and the medial dislocation of the associated main hallux MTP joint resulting in varus and the oblique planar of the metatarsal articulations. The deformity of hallux varus and the deficiency of tibial skin were the characteristics and the difficulties of this special type of preaxial polysyndactyly. Good axial correction can be obtained by means of opening osteotomy and intraoperative release of abductor insertion. Then the wound can be closed at one stage without skin grafting by using a double Z-plasty incision which could fully elongate the tibial side skin.