Sharma Alok, Sharma Namita
Professor and Consultant Plastic Surgeon, Commandant Military Hospital, Jabalpur, Madhya Pradesh, India.
Department of Human Anatomy, Bharati Vidyapeeth Deemed University, Dental College and Hospital, Pune, Maharashtra, India.
Indian J Plast Surg. 2017 Sep-Dec;50(3):244-250. doi: 10.4103/ijps.IJPS_8_17.
Phenotypic expressions of the congenital cleft hand are variable and might baffle even the experienced as to the choice of surgery. The morphological parameters defining the anomaly dictate not only the functional capacity of the anomalous hand but also the degree of possible surgical restoration. Despite a large number of classifying systems available, none encompass all the relevant issues.
The purpose of this work is to present an all-inclusive and universally acceptable classification of the deformity which would graphically represent the entire gamut of possible presentations; principal and associated. Furthermore, based on such staging, the choice of surgical procedure and the stages of surgical intervention can be standardised to ensure the best results for the patient.
This study is based on a series of 27 patients with a total of 38 cleft hands.
The necessity to include and to assess all determinants of function and complexity in these hands to standardise the choice of management, gave rise to the DAST system of classification; an acronym for all the morphological determinants of the anomaly (D = Digits missing, A = Associated anomalies in the hand, S = Site of cleft, T = Functional state of the Thumb). Numerical values were assigned to each component in increasing order of complexity. Score for each determinant as well as the aggregate score indicates the degree of complexity in a graphic manner. The DAST classification has a predictive value in choice of procedure and prognosticating surgical outcomes.
先天性裂手的表型表现多样，即便经验丰富的医生在手术选择上也可能感到困惑。界定该畸形的形态学参数不仅决定了畸形手的功能能力，还决定了可能的手术修复程度。尽管有大量可用的分类系统，但没有一个能涵盖所有相关问题。
本研究的目的是提出一种全面且普遍可接受的畸形分类方法，该方法能以图形方式呈现所有可能的表现形式，包括主要和相关的表现。此外，基于这样的分期，可以使手术方法的选择和手术干预的阶段标准化，以确保为患者取得最佳效果。
本研究基于一系列27例患者，共38只裂手。
为了标准化治疗选择，需要纳入并评估这些手部功能和复杂性的所有决定因素，由此产生了DAST分类系统；该系统是畸形所有形态学决定因素的首字母缩写（D = 缺如手指，A = 手部相关畸形，S = 裂的部位，T = 拇指的功能状态）。按照复杂性递增顺序为每个组成部分赋予数值。每个决定因素的得分以及总分以图形方式显示复杂程度。DAST分类在手术方法选择和手术结果预后方面具有预测价值。
