吴等人A2型先天性拇指重复畸形的影像学特征及其对治疗的意义：新亚型和手术策略
Radiographic features of Wu et al. type A2 congenital thumb duplication and implications for management: new subtypes and surgical strategies.
作者信息
Wu JianPing, Liao ShiJie, Li YuQuan, Xu FuLong, Zhao Hai, Li ChenYang, Liu YanHan, Zhi XinWang, Lin HongHong, Tu ZheHui, Shu LiLi, Li JingChun, Li YiQiang, Canavese Federico, Xu HongWen, Liu YuanZhong
机构信息
Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, Guangdong Provincial Clinical Research Center for Child Health, GuangZhou Medical University, GuangZhou, China.
Department of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
出版信息
Front Pediatr. 2025 Mar 10;13:1536872. doi: 10.3389/fped.2025.1536872. eCollection 2025.
OBJECTIVE
This study aimed to assess the radiographic features of patients diagnosed with congenital thumb duplication (CTD) type A2 based on the Wu et al. classification, describe the different subtypes of duplications and propose a classification system that permits identifying various surgical strategies.
METHODS
We evaluated 665 patients (680 thumbs) diagnosed with type A2 CTDs by examining the alignment of the interphalangeal (IP) and metacarpophalangeal (MP) joints of the primary thumb on posteroanterior (PA) radiographs. The classification system has four types: Type I (no deviation); Type II (ulnar deviation); Type III (hypertrophic epiphysis); and Type IV (convergent). Types I-IV were compared to Hung et al.'s system Type A-D (Hypoplastic, Ulnar Deviation, Divergent, and Convergent).
RESULTS
Of the 680 fingers, 436 (64.1%) were determined to be Wassel type IV while 244 (35.9%) were classified as Wassel type VII. All of the 436 fingers could be categorized according to the subtypes of the Hung et al. system; in particular, 369 (84.6%) were identified as type B, 52 (11.9%) as type D, and 15 cases (3.4%) as type C. The proposed classification system worked effectively for all CTDs ( = 680). 494 cases were classified as type II (72.6%), while 75 cases were classified as type I (11.0%). The remaining 111 cases were further classified as either type IV (9.3%) or type III (7.1%). The Wu et al. systems showed excellent intra-rater (0.881) and inter-rater (0.873) reliability compared to the Hung et al. systems (0.842 and 0.823, respectively).
CONCLUSIONS
The proposed radiographic pathoanatomical system has the potential to improve communication and guide optimal procedure selection for different subtypes of CTD depending on the attachment of the extra digit to the main thumb and the alignment of the interphalangeal and metacarpophalangeal joints of the primary thumb (Wu et al. type A2).
LEVEL OF EVIDENCE
III.
目的
本研究旨在根据Wu等人的分类法评估诊断为A2型先天性拇指重复畸形（CTD）患者的影像学特征，描述重复畸形的不同亚型，并提出一种能够确定各种手术策略的分类系统。
方法
我们通过检查正位（PA）X线片上主要拇指的指间（IP）关节和掌指（MP）关节的对线情况，对665例诊断为A2型CTD的患者（680个拇指）进行了评估。该分类系统有四种类型：I型（无偏斜）；II型（尺侧偏斜）；III型（骨骺肥大）；IV型（汇聚型）。将I - IV型与Hung等人的A - D型系统（发育不全型、尺侧偏斜型、发散型和汇聚型）进行比较。
结果
在680个手指中，436个（64.1%）被确定为Wassel IV型，244个（35.9%）被归类为Wassel VII型。436个手指均可根据Hung等人系统的亚型进行分类；具体而言，369个（84.6%）被确定为B型，52个（11.9%）为D型，15个（3.4%）为C型。所提出的分类系统对所有CTD（n = 680）均有效。494例被分类为II型（72.6%），而75例被分类为I型（11.0%）。其余111例进一步分类为IV型（9.3%）或III型（7.1%）。与Hung等人的系统（分别为0.842和0.823）相比，Wu等人的系统显示出极好的观察者内（0.881）和观察者间（0.873）可靠性。
结论
所提出的影像学病理解剖系统有可能改善沟通，并根据额外手指与主要拇指的附着情况以及主要拇指的指间关节和掌指关节的对线情况（Wu等人的A2型），为不同亚型的CTD指导最佳手术方案的选择。
证据水平
III级。
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