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引用次数: 0
摘要
研究目的本研究旨在根据吴等人的分类方法，评估被诊断为先天性拇指重复（CTD）A2型患者的放射学特征，描述重复的不同亚型，并提出一个分类系统，以确定各种手术策略：方法：我们对 665 名患者（680 个拇指）进行了评估，通过后前位（PA）X 光片检查原拇指指间关节（IP）和掌指关节（MP）的对齐情况，确诊为 A2 型 CTD。该分类系统分为四种类型：I 型（无偏斜）；II 型（尺侧偏斜）；III 型（骨骺肥厚）；IV 型（收敛）。将 I-IV 型与 Hung 等人的系统 A-D 型（发育不良型、尺侧偏离型、偏离型和收敛型）进行了比较：结果：在 680 个手指中，436 个（64.1%）被确定为瓦塞尔 IV 型，244 个（35.9%）被归类为瓦塞尔 VII 型。所有 436 根手指均可根据 Hung 等人的系统进行亚型分类，其中 369 根（84.6%）被确定为 B 型，52 根（11.9%）为 D 型，15 根（3.4%）为 C 型。其中 494 例（72.6%）被归为 II 型，75 例（11.0%）被归为 I 型。其余 111 个病例被进一步分类为 IV 型（9.3%）或 III 型（7.1%）。与Hung等人的系统（分别为0.842和0.823）相比，Wu等人的系统在评分者内部（0.881）和评分者之间（0.873）显示出极佳的可靠性：结论：根据额外指骨与主拇指的附着情况以及主拇指指间关节和掌指关节的对齐情况（Wu等人，A2型），所提出的放射病理解剖学系统有可能改善沟通并指导不同亚型CTD的最佳手术选择：证据等级：III.
Radiographic features of Wu et al. type A2 congenital thumb duplication and implications for management: new subtypes and surgical strategies.
Objective: This study aimed to assess the radiographic features of patients diagnosed with congenital thumb duplication (CTD) type A2 based on the Wu et al. classification, describe the different subtypes of duplications and propose a classification system that permits identifying various surgical strategies.
Methods: We evaluated 665 patients (680 thumbs) diagnosed with type A2 CTDs by examining the alignment of the interphalangeal (IP) and metacarpophalangeal (MP) joints of the primary thumb on posteroanterior (PA) radiographs. The classification system has four types: Type I (no deviation); Type II (ulnar deviation); Type III (hypertrophic epiphysis); and Type IV (convergent). Types I-IV were compared to Hung et al.'s system Type A-D (Hypoplastic, Ulnar Deviation, Divergent, and Convergent).
Results: Of the 680 fingers, 436 (64.1%) were determined to be Wassel type IV while 244 (35.9%) were classified as Wassel type VII. All of the 436 fingers could be categorized according to the subtypes of the Hung et al. system; in particular, 369 (84.6%) were identified as type B, 52 (11.9%) as type D, and 15 cases (3.4%) as type C. The proposed classification system worked effectively for all CTDs (n = 680). 494 cases were classified as type II (72.6%), while 75 cases were classified as type I (11.0%). The remaining 111 cases were further classified as either type IV (9.3%) or type III (7.1%). The Wu et al. systems showed excellent intra-rater (0.881) and inter-rater (0.873) reliability compared to the Hung et al. systems (0.842 and 0.823, respectively).
Conclusions: The proposed radiographic pathoanatomical system has the potential to improve communication and guide optimal procedure selection for different subtypes of CTD depending on the attachment of the extra digit to the main thumb and the alignment of the interphalangeal and metacarpophalangeal joints of the primary thumb (Wu et al. type A2).
期刊介绍：
Frontiers in Pediatrics (Impact Factor 2.33) publishes rigorously peer-reviewed research broadly across the field, from basic to clinical research that meets ongoing challenges in pediatric patient care and child health. Field Chief Editors Arjan Te Pas at Leiden University and Michael L. Moritz at the Children''s Hospital of Pittsburgh are supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.
Frontiers in Pediatrics also features Research Topics, Frontiers special theme-focused issues managed by Guest Associate Editors, addressing important areas in pediatrics. In this fashion, Frontiers serves as an outlet to publish the broadest aspects of pediatrics in both basic and clinical research, including high-quality reviews, case reports, editorials and commentaries related to all aspects of pediatrics.
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