Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China.
Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China.
J Ultrasound Med. 2024 Sep;43(9):1733-1744. doi: 10.1002/jum.16508. Epub 2024 Jun 12.
This study aimed to establish a simple and practical classification to guide the clinical treatment of diastasis recti abdominis (DRA) based on ultrasound characteristics with different severities of DRA, and to verify its clinical utility.
We retrospectively enrolled 301 DRA patients as pilot cohort and divided into Conservative Treatment Group and Surgical Group according to clinical outcomes. A new Width-Length classification was summarized based on ultrasound measurements of the width and length of midline separation. Then, 100 DRA patients were enrolled prospectively as validation cohort, and diagnostic performance was evaluated by clinical treatment.
The Width-Length classification in pilot cohort was as follows: Type 1 (n = 108), open only at M3; Type 2 (n = 63), open at M3 and either M2 or M4 (inter-rectus distance at M3 <47 mm); Type 3 (n = 44), open at M3 and either M2 or M4 (inter-rectus distance at M3 ≥47 mm); Type 4 (n = 74), open at M3, along with other two sites of M1, M2, M4, or M5; Type 5 (n = 12), open at M2, M3, and M4, along with M1 or M5, or both. DRA patients in Type 1-2 were recommended for conservative treatment, and in Type 3-5 were recommended for surgical treatment (all P < .05). In the validation cohort, the accuracy of Width-Length classification in determining treatment strategy was 86.0%.
This study proposes a Width-Length classification based on the width and length of midline separation on ultrasound, which was validated to be simple, practical and effective in guiding DRA treatment.
本研究旨在根据超声特征建立一种简单实用的分类方法，指导不同严重程度腹直肌分离（DRA）的临床治疗，并验证其临床实用性。
我们回顾性纳入 301 例 DRA 患者作为试点队列，并根据临床结果分为保守治疗组和手术组。根据中线分离的宽度和长度的超声测量，总结了一种新的宽度-长度分类。然后，前瞻性纳入 100 例 DRA 患者作为验证队列，通过临床治疗评估诊断性能。
试点队列中的宽度-长度分类如下：1 型（n=108），仅在 M3 处开放；2 型（n=63），在 M3 处开放，并且在 M2 或 M4 处开放（M3 处的腹直肌间距离<47mm）；3 型（n=44），在 M3 处开放，并且在 M2 或 M4 处开放（M3 处的腹直肌间距离≥47mm）；4 型（n=74），在 M3 处开放，同时在 M1、M2、M4 或 M5 的其他两个部位开放；5 型（n=12），在 M2、M3 和 M4 处开放，同时在 M1 或 M5 处开放，或同时在 M1 和 M5 处开放。建议 1 型-2 型 DRA 患者接受保守治疗，建议 3 型-5 型 DRA 患者接受手术治疗（均 P<0.05）。在验证队列中，Width-Length 分类确定治疗策略的准确性为 86.0%。
本研究提出了一种基于超声中线分离宽度和长度的 Width-Length 分类方法，验证结果表明其简单、实用、有效，可指导 DRA 治疗。
