Husarik Daniela, Vavricka Stephan R, Mark Michael, Schaffner Andreas, Walter Roland B
Department of Internal Medicine, Medical Clinic B, University Hospital Zürich, Switzerland.
Swiss Med Wkly. 2002 Mar 23;132(11-12):132-8. doi: 10.4414/smw.2002.09907.
Digital clubbing has been associated with a large number of disorders. To overcome the limitation of subjective clinical assessment, several objective measurements have been developed among which the hyponychial angle was considered most accurate for quantification of finger clubbing.
Here we investigated hyponychial angles in 123 healthy subjects and 515 medical inpatients from a tertiary hospital. Healthy subjects had a mean angle of 178.87 +/- 4.70 degrees (range: 164.78-192.10 degrees ), a finding that is well in accordance with previous results obtained using other techniques, underlining the accuracy of the chosen method of assessment. The mean angle of patients was 181.65 +/- 7.18 degrees (range: 162.22-209.19; p <0.0001 compared to healthy controls). When the upper limit of normality, i.e. 192.10 degrees, was used to define digital clubbing, the prevalence of digital clubbing in our patients was 8.9%; the percentage of clubbed fingers varied substantially among the various disease states (up to 80% in patients with cystic fibrosis).
The use of digital photography with computerised analysis was found to be an easy, fast and inexpensive method for the quantification of hyponychial angles with excellent intra and inter observer reliability whilst causing no discomfort to patients. This tool may therefore be useful in further longitudinal and cross-sectional studies of finger morphology and may become an accepted standard in the diagnosis of digital clubbing.
杵状指与大量疾病相关。为克服主观临床评估的局限性，已开发出多种客观测量方法，其中甲床下角被认为是量化手指杵状变最准确的方法。
我们在此研究了一家三级医院的123名健康受试者和515名住院患者的甲床下角。健康受试者的平均角度为178.87±4.70度（范围：164.78 - 192.10度），这一结果与使用其他技术获得的先前结果高度一致，突出了所选评估方法的准确性。患者的平均角度为181.65±7.18度（范围：162.22 - 209.19；与健康对照组相比，p<0.0001）。当用正常上限即192.10度来定义手指杵状变时，我们患者中手指杵状变的患病率为8.9%；在不同疾病状态下，杵状指的比例差异很大（囊性纤维化患者中高达80%）。
使用数码摄影结合计算机分析被发现是一种简单、快速且廉价的方法，用于量化甲床下角，具有出色的观察者内和观察者间可靠性，同时不会给患者带来不适。因此，该工具可能有助于进一步对手指形态进行纵向和横断面研究，并可能成为手指杵状变诊断的公认标准。
