目的:理想的分类系统可促进交流并指导先天性上肢差异(CULDs)的治疗。Oberg,Manske,Tonkin(OMT)分类利用表型表现和发育生物学知识对CULDs进行分类。在这项共识决策研究中,我们假设一组经验丰富的儿科手外科医师对难以分类的CULDs进行了相同的分类.
方法:一个由3个国家的14名儿科手外科医师组成的国际联盟提供了72例难以分类的CLD病例。这些是从外科医生的临床实践和相关注册表中确定的。通过Delphi型过程,我们反复努力,利用临床影像和X线照片,就每个病例的正确OMT分类达成共识.
结果:第一轮讨论对57例病例达成了普遍共识。其余15例继续进行Delphi型流程的其他回合。重复分类和讨论导致OMT在分类中最终获得93%的完全共识。诊断的主要挑战是区分裂手和尺纵行缺陷,确定为A组,该组有5例,然而,2仍然没有明确的共识。另一个有争议的团体,B组,被称为“brachy-polydactyly”,由3例诊断不同的病例组成,合音尖顶,或复杂的连音。
结论:Delphi型方法是可行和有效的,在OMT分类法诊断难以分类的病例方面有93%的共识。OMT系统仍然存在局限性和争议,尤其是对少于5个骨骼数字的手进行分类时,齐体,尺骨纵向缺陷和裂手之间有诊断重叠的人和那些被认为是短指多指的人。“在难以分类的情况下,可能需要更好地了解潜在病因,以确定最终诊断。
结论:寻求共识的方法在解决难以分类的CULDs方面是有效和可行的。
OBJECTIVE: An ideal classification system promotes communication and guides treatment for congenital upper limb differences (CULDs). The Oberg, Manske, and Tonkin (OMT) classification utilizes phenotypic presentation and knowledge of developmental biology for the classification of CULDs. In this
consensus decision-making study, we hypothesized that CULDs that are difficult to classify would be identically classified by a group of experienced pediatric hand surgeons.
METHODS: An international consortium of 14 pediatric hand surgeons in 3 countries contributed a group of 72 difficult-to-classify CULD cases. These were identified from the clinical practices of the surgeons and from associated registries. Through a Delphi-type process, repeated efforts were made to obtain consensus for the correct OMT classification of each case utilizing clinical images and radiographs.
RESULTS: The first round of discussion yielded a universal
consensus for 57 cases. The remaining 15 cases continued to be put through additional rounds of the Delphi-type process. The repeat classification and discussion resulted in a final yield of 93% complete
consensus in classification by the OMT. The primary challenge in diagnosis was differentiating cleft hand from ulnar longitudinal deficiency, identified as group A. Five cases were in this group, yet 2 remained without a clear
consensus. Another controversial group, group B, was termed \"brachy-polydactyly\" and consisted of 3 cases where diagnoses varied between sympolydactyly, symbrachydactyly, or complex syndactyly.
CONCLUSIONS: The Delphi-type process was feasible and effective and allowed a 93%
consensus in the diagnosis of difficult-to-classify cases by the OMT Classification. There remain limitations and controversies with the OMT system, especially when classifying hands with less than 5 skeletal digits, syndactyly, and those with diagnostic overlap between ulnar longitudinal deficiency and cleft hand and those considered \"brachypolydactyly.\" An improved understanding of the underlying etiology may be needed to determine the final diagnosis in difficult-to-classify conditions.
CONCLUSIONS: A consensus-seeking approach is effective and feasible in addressing difficult-to-classify CULDs.