Baas Martijn, Zwanenburg Pieter R, Hovius Steven E R, van Nieuwenhoven Christianne A
Department of Plastic and Reconstructive Surgery and Hand Surgery. Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Plastic and Reconstructive Surgery and Hand Surgery. Erasmus University Medical Center, Rotterdam, The Netherlands.
J Hand Surg Am. 2018 Sep;43(9):869.e1-869.e11. doi: 10.1016/j.jhsa.2018.02.003. Epub 2018 Mar 21.
Congenital upper limb anomalies (CULAs) exhibit a wide spectrum of phenotypic manifestations. To help the clinician evaluating this variety of CULAs, the Oberg, Manske, and Tonkin (OMT) classification was recently introduced. The OMT classification allows for documentation of combined hand anomalies. However, subsequent epidemiological and validation studies using the OMT scheme commonly registered only the main anomaly per arm. This study illustrates both the deficits of single diagnosis documentation as well as the merits of registering every anomaly for epidemiological research, outcome comparison, and overall applicability of the classification.
We retrospectively reviewed patients visiting the Erasmus MC - Sophia Children's Hospital between 2012 and 2014. All congenital anomalies of both limbs were classified according to the OMT scheme. The frequency of combined diagnoses as well as recurrent combinations were analyzed. The relation to the coregistered syndromes was studied.
We included 746 patients, 79.5% of whom could be documented with a single OMT diagnosis. In 20.5%, a combination of OMT diagnoses was documented. We documented 149 different combinations: 102 were documented once, 47 were documented repeatedly (n = 196); for example, in patients with Greig syndrome. The prevalence of this syndrome was significantly higher in patients with a combination of radial polydactyly, ulnar polydactyly, and/or syndactyly (2.9% vs 33.3% and 60% in patients with 1 vs 2 and 3 diagnoses).
Documentation of combined OMT diagnoses is required in a fifth of the patients. Not doing so will cause loss of phenotypic information and can hamper outcome comparison and epidemiological research. Documentation of combined OMT diagnoses can help to identify subgroups within a population, for example, patients with an underlying syndrome. Last, combined documentation of diagnoses improves flexibility of the classification and thereby better allows universal application.
Consensus on the application of the OMT classification is critical to achieving the universal adoption of the system by hand surgeons and other medical professionals.
先天性上肢畸形（CULA）表现出广泛的表型表现。为帮助临床医生评估各种CULA，最近引入了奥伯格、曼斯克和汤金（OMT）分类法。OMT分类法允许记录合并的手部畸形。然而，随后使用OMT方案进行的流行病学和验证研究通常仅记录每只手臂的主要畸形。本研究阐述了单一诊断记录的不足以及为流行病学研究、结果比较和分类的整体适用性记录每一种畸形的优点。
我们回顾性分析了2012年至2014年间在伊拉斯姆斯医学中心 - 索菲亚儿童医院就诊的患者。根据OMT方案对双上肢的所有先天性畸形进行分类。分析合并诊断的频率以及反复出现的组合。研究与同时记录的综合征的关系。
我们纳入了746例患者，其中79.5%可以用单一的OMT诊断记录。20.5%的患者记录了OMT诊断的组合。我们记录了149种不同的组合：102种只记录了一次，47种被反复记录（n = 196）；例如，在患有格雷格综合征的患者中。在合并桡侧多指畸形、尺侧多指畸形和/或并指畸形的患者中，该综合征的患病率显著更高（1种诊断的患者中为2.9%，2种诊断的患者中为33.3%，3种诊断的患者中为60%）。
五分之一的患者需要记录OMT合并诊断。不这样做会导致表型信息丢失，并可能妨碍结果比较和流行病学研究。记录OMT合并诊断有助于识别群体中的亚组，例如患有潜在综合征的患者。最后，合并诊断记录提高了分类的灵活性，从而更好地允许普遍应用。
就OMT分类法的应用达成共识对于手部外科医生和其他医学专业人员普遍采用该系统至关重要。
