WasselⅣ型先天性多拇畸形不同Chung分型的影像学特征研究

Analysis of imaging Features of different Chung type of Wassel typeⅣcongnital thumb polydactyly

目的评估WasselⅣ型先天性多拇畸形Chung分型的影像学特征。方法以2015年6月至2018年6月温州医科大学附属第二医院手外科收治的40例WasselⅣ型先天性多拇畸形病例为研究对象,收集患儿术前X线片、MRI以及术中诊断。通过测量术前手正(侧)位X线片上桡侧拇与尺侧拇之间的轴线夹角、基底间距等影像学指标,计算正(侧)位片轴线夹角×基底间距、正(侧)位片轴线夹角/基底间距、侧位片轴线夹角/正位片基底间距等,使用SPSS 26软件进行统计学分析。结果平均正位片间距:ChungⅠ型患儿为(4.1±0.44)mm,ChungⅡ型患儿为(1.71±0.27)mm;平均侧位片夹角:ChungⅠ型患儿为(47.26±3.60)°,ChungⅡ型患儿为(72.44±4.89)°;平均正位片夹角/间距:ChungⅠ型患儿为(17.23±2.59)°/mm,ChungⅡ型患儿为(41.81±8.43)°/mm;平均侧位片夹角/间距:ChungⅠ型患儿为(14.30±1.57)°/mm,ChungⅡ型患儿为(26.73±3.31)°/mm;平均侧位片夹角/正位片间距:ChungⅠ型患儿为(18.37±3.45)°/mm,ChungⅡ型患儿为(50.97±11.37)°/mm,以上结果差异均具有统计学意义(P<0.05)。以ChungⅡ型为阳性结果绘制ROC曲线,侧位片轴线夹角/正位片基底间距的ROC曲线下面积(0.929)高于侧位片夹角(0.859)、正位片夹角/间距(0.91)和侧位片夹角/间距(0.859)。侧位片轴线夹角/正位片基底间距在ROC曲线上截断点为27.41°/mm。结论术前测量并计算侧位片轴线夹角/正位片基底间距,可辅助术前WasselⅣ型患儿的Chung分型,从而预测患儿的预后和指导临床治疗。

Objective To evaluate the imaging features of different Chung types of Wassel typeⅣcongenital thumb polydactyly.Methods From June 2015 to June 2018,40 children hospitalized with Wassel typeⅣpolydactyly were selected as research subjects.Radiography,magnetic resonance imaging(MRI)and intraoperative diagnosis were collected.Axial angle and basal spacing on anteroposterior and lateral radiographs were measured and angle×interspace distance on anteroposterior and lateral film axial,axial angle/interspace distance on anteroposterior and lateral film,axial angle on lateral film×interspace distance on anteroposterior film were calculated.Independent sample t test was performed by SPSS software and receiver operating characteristic(ROC)curve plotted.Results The average interspace distance on anteroposterior film was(4.1±0.44)mm for Chung typeⅠpatients and(1.71±0.27)mm for Chung typeⅡpatients.The average axial angle on lateral film was(47.26±3.60)°for Chung typeⅠpatients and(72.44±4.89)°for Chung typeⅡpatients.The average axial angle/interspace distance on anteroposterior film was(17.23±2.59)°/mm for Chung typeⅠpatients and(41.81±8.43)°/mm for Chung typeⅡpatients.The average axial angle/interspace distance on lateral film was(14.30±1.57)°/mm for Chung typeⅠpatients and(26.73±3.31)°/mm for Chung typeⅡpatients.The average angle on lateral film/interspace distance on anteroposterior film was(18.37±3.45)°/mm for Chung typeⅠpatients and(50.97±11.37)°/mm for Chung typeⅡpatients.The above results had statistically differences(P<0.05).ChungⅡtype was used as the positive result to plot the ROC curve.The area under the ROC curve of angle on lateral film/interspace distance on anteroposterior film(0.929)was higher than axial angle on lateral film(0.859),axial angle/interspace distance on anteroposterior film(0.91)and axial angle/interspace distance on lateral film(0.859).The Cut-off point of the angle on lateral film/interspace distance on anteroposterior film was 27.41°/mm in ROC curve.Conclusion The preoperative measurements and calculations of angle on lateral film/interspace distance on anteroposterior film may be used for distinguishing Chung types of polydactyly.