目的:这项研究的目的是(1)评估2015年8月至2021年4月在我们机构中发现的先天性拇指重复(CTD)儿童的影像学特征;(2)引入一种改进的影像学分类系统(MCS),该系统能够根据其影像学病理解剖将所有CTD病例包括在内;(3)评估新分类系统的鼠间和鼠内可靠性。
方法:我们回顾性分析了2,108例患者和2,300例CTDs。MCS基于Wassel-Flatt和Chung等人的分类系统,包括鹿特丹的特定亚型和经过修改的Wassel-Flatt分类。根据重复的解剖形态,MCS的特征是4组:A(关节),B(骨phy),C(骨),和D(软组织)。根据CTD的位置,每组包括4种亚型,亚型1-3从远端指骨延伸到掌骨或指间关节,然后到腕掌关节,亚型4只包括大拇指的三指节。
结果:在2,300个手指中,360(15.7%),2(0.1%),和3(0.1%)CTD不能根据Wassel-Flatt分类,Chung等人,和鹿特丹分类,分别。根据MCS,最常见的两种CTD形式是A2(680/2,300;29.6%)和D2(308/2,300;13.4%)。所有病例都可以根据这个分类系统进行分类。MCS相对于Wassel-Flatt(分别为0.863和0.820)显示出出色的内部(0.875)和中间(0.851)可靠性,Chung等人(分别为0.793和0.822),和鹿特丹(分别为0.873和0.836)系统。
结论:MCS是CTD的潜在影像学分类,可以对所有患者进行分类,并具有出色的内部和内部可靠性。
结论:现有的分类系统不允许对CTD的全谱进行分类,并且并不总是与手术有关,一些现有的系统很复杂,有许多很少遇到的类别,或难以在临床实践中广泛使用。
OBJECTIVE: The objectives of this study were to (1) evaluate the radiographic characteristics of children with congenital thumb duplication (CTD) seen in our institution between August 2015 and April 2021; (2) introduce a modified radiographic classification system (MCS) capable of including all cases of CTD based on their radiographic pathoanatomy; and (3) evaluate the inter- and intrarater reliability of the new classification system.
METHODS: We retrospectively reviewed 2,108 patients with 2,300 CTDs. The MCS is based on the Wassel-Flatt and Chung et al classification systems and includes specific subtypes from the Rotterdam and modified Wassel-Flatt classifications. The MCS is characterized by 4 groups according to the anatomical morphology of the duplication: A (joint), B (epiphysis), C (bone), and D (soft tissues). Each group includes 4 subtypes according to the location of the CTD, with subtypes 1-3 extending from the distal phalanx to the metacarpal or interphalangeal joints, then to the carpometacarpal joint, and with subtype 4 only including the triphalangia of the main thumb.
RESULTS: Among the 2,300 fingers, 360 (15.7%), 2 (0.1%), and 3 (0.1%) CTDs could not be classified according to the Wassel-Flatt, Chung et al, and Rotterdam classifications, respectively. According to the MCS, the 2 most common forms of CTD were A2 (680/2,300; 29.6%) and D2 (308/2,300; 13.4%). All cases could be classified according to this classification system. The MCS showed excellent intrarater (0.875) and interrater (0.851) reliability relative to the Wassel-Flatt (0.863 and 0.820, respectively), Chung et al (0.793 and 0.822, respectively), and Rotterdam (0.873 and 0.836, respectively) systems.
CONCLUSIONS: The MCS is a potential radiographic classification for CTD that enables the classification of all patients and has excellent inter- and intrarater reliability.
CONCLUSIONS: Existing classification systems do not allow classification of the full spectrum of CTD and are not always related to surgery, and some existing systems are complex, with many categories that are rarely encountered, or are difficult to use widely in clinical practice.