掌指关节水平分裂型复拇畸形的X线片分型  

X-ray classification of thumb duplication of cleft type at the metacarpophalangeal joint level

作　　者：钟文耀 田文[1] 赵俊会[1] 孙丽颖[1] 郭阳[1] 殷悦涵 张楠 Zhong Wenyao;Tian Wen;Zhao Junhui;Sun Liying;Guo Yang;Yin Yuehan;Zhang Nan(Department of Hand Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院手外科,北京100035

出　　处：《中华手外科杂志》2021年第2期94-98,共5页Chinese Journal of Hand Surgery

基　　金：北京积水潭医院院级基金 (2019-YJ03);国家重点研发计划-罕见病临床队列研究-精准医学研究专项 (2016YFC0901500)。

摘　　要：目的通过分析掌指关节水平分裂型复拇畸形的X线表现,探讨该类型复拇畸形的X线分型。方法自2013年1月至2019年6月我科治疗264例掌指关节水平分裂型复拇畸形,根据X线片所示桡、尺侧指的相对发育程度,可将复拇畸形分为四大类型。A型,桡、尺侧指发育基本一致;B型,桡侧指更加发育不良;C型,尺侧指更加发育不良;D型,桡、尺侧指远近端发育不平衡。综合发育程度和骨关节力线情况,可进一步分出亚型。B型病例可分为5个亚型。B1型,尺侧指掌指关节和指间关节力线异常;B2型,尺侧指掌指关节力线异常;B3型,尺侧指力线无明显异常;B4型,尺侧指近节指骨畸形肥大,且力线异常;B5型,桡侧指为漂浮拇指。其余类型病例无亚型。结果以X线片上桡、尺侧指的相对发育程度和骨关节力线情况,本组分为A型41例,B型216例。其中B1型64例,B2型54例,B3型63例,B4型26例,B5型9例;C型1例,D型6例。结论该分型方法的依据明确,能较全面反映掌指关节水平分裂型复拇畸形骨关节的病理解剖机制,为手术治疗提供指导。Objective Objective To explore the X-ray classification of thumb duplication of cleft type at the metacarpophalangeal joint level according to the imaging features on X-ray.Methods From January 2013 to June 2019,264 cases of thumb duplication of cleft type at the metacarpophalangeal joint level were treated in our department.According to the relative development degree of the radial and ulnar thumbs on the X-ray film,the deformity can be divided into four types.In type A,the development of radial and ulnar thumbs was basically the same;in type B,the development of radial thumb was more dysplasia;in type C,the development of ulnar thumb was more dysplasia;in type D,the development of distal and proximal ends of radial and ulnar thumbs was unbalanced.According to the degree of development and the force line of joint,the subtypes could be further divided.Type B cases can be divided into five subtypes.In type B1,the force line of metacarpophalangeal joint and interphalangeal joint of ulnar thumb was abnormal;in type B2,the force line of metacarpophalangeal joint of ulnar thumb was abnormal;in type B3,the force line of ulnar thumb had no obvious abnormality;in type B4,the proximal phalanx of ulnar thumb was malformed and hypertrophic,and the force line was abnormal;in type B5,the radial thumb was floating.There was no subtype in other types.Results According to the relative development degree of the radial and ulnar thumbs on the X-ray film and the force line of joint,41 cases were classified as type A and 216 cases as type B.There were 64 cases of type B1,54 cases of type B2,63 cases of type B3,26 cases of type B4,9 cases of type B5,1 case of type C and 6 cases of type D.Conclusion The basis of this classification method is clear,which can comprehensively reflect the pathoanatomical mechanism of joint of thumb duplication of cleft type at the metacarpophalangeal joint level,and provide guidance for surgical treatment.

关 键 词：手畸形 先天性 掌指关节 复拇 X线片 分型 

分 类 号：R687.3[医药卫生—骨科学]