拇指发育不良的特点及相关因素对于疾病分型的影响

目的探讨拇指发育不良的特点及相关因素对于疾病分型的影响。方法回顾性分析2014年1月至2019年9月在北京积水潭医院手外科就诊的63例拇指发育不良患者的病历资料。统计并分析其疾病特点,分别比较不同侧别患者父母年龄的均值、不同侧别及不同分型中合并其他发育缺陷发生率以及不同分型中各影响因素所占的比例。结果男女比例为1.9∶1。Blauth分型:Ⅱ型占7.6%,ⅢA型占8.9%,ⅢB型占36.7%,Ⅳ型占38.0%,Ⅴ型占8.9%。累及双手的患者较右手单侧的患者,其孕时父母的年龄比较,差异有统计学意义(P<0.05)。合并其他畸形者占58.7%,其中心脏畸形占54.1%,同侧肢体其他畸形占32.4%。有阳性家族史占11.1%,母亲孕早期接触放射线占4.8%,孕早期家庭或工作单位装修占19.0%,孕期患有糖尿病占15.9%,既往有流产史占46.0%,保胎史占63.5%,孕早期感冒占20.6%。不同分型中合并其他发育缺陷的发生率比较,差异无统计学意义(P>0.05)。结论拇指发育不良多见于男性,以BlauthⅢ、Ⅳ型为主,可单独发病,也可与其他系统疾病共同出现。遗传、环境、不良孕产经历等因素均可能导致该疾病的发生。

The characteristics of thumb dysplasia and the influence of related factors on disease classification

Objective To investigate the characteristics of thumb dysplasia and the influence of related factors on disease classification.Methods A retrospective analysis was performed on the medical records of 63 patients with thumb dysplasia in Department of Hand Surgery,Beijing Jishuitan Hospital from January 2014 to September 2019.The disease characteristics were recorded and analyzed.The average age of parents of patients in different sides,the ratio of combining other developmental defects in different sides and different subtypes,and the proportion of various influencing factors in different subtypes were compared.Results The male to female ratio was 1.9∶1.According to Blauth classification,typeⅡwas 7.6%,typeⅢA was 8.9%,typeⅢB was 36.7%,and typeⅣwas 38.0%,typeⅤwas 8.9%.Patients with both hands had a statistically significant difference in the age of their parents during pregnancy compared with patients with one side of the right hand(P<0.05).58.7%of patients were combined with other malformations,of which 54.1%were cardiac malformations and 32.4%were other deformities of the ipsilateral limbs.Children with a positive family history accounted for 11.1%.In first trimester,4.8%of mothers exposed to radiation,and 31.8%exposed to chemical poisons.15.9%of mothers got diabetes,54.0%got the history of miscarriage,and then 65.1%had the treatment due to it.20.6%of mothers got cold in the first trimester.There was no statistical difference between the rates of combining other developmental defects in different types.Conclusions Thumb dysplasia had a male preference,and common types were Blauth typeⅢand typeⅣ,which can occur alone or in combination with other systemic diseases.It is a multifactorial disease,and genetic,environmental,and negative maternal experiences may have adverse effects.