Reviewer #2(审稿人2):
The authors described a novel classification system for thumb polydactyly based on surgical technique. This is a large, impressive series of 335 patients, and the classification achieved good inter and intra reliability scores. The manuscript is reasonably well-written and easy to read. The following are my comments:
作者描述了一种基于手术技术的新型拇指多指分型系统。这是一系列令人印象深刻的335名患者的系列,该分型获得了良好的内部和内部可靠性评分。手稿写得很好并且易于阅读。以下是我的评论: 感悟:自我感觉病例数和方法还行,其实后来回想病例数不一定非要多,方法也有很多,文献阅读不够,需要多多阅读文献,特别是我们资历尚浅的医师。文稿语言是经过专业人员修改过,但是具体的格式和整体的架构是自己摸索弄得,这里其实有很大的问题,我感觉是不是逻辑性的问题,但是不敢确认,因为从后来的修改中回想起来,如果一开始得到架构上的指导,应该会有另外一种效果。我感觉一开始动笔前设计架构需要请教有经验的老师指导和点拨。
Is it new? 是否新颖?
No, I do not think there is sufficiently new information. The presentations are well-known, and every congenital hand surgeon should be able to look at the morphology of each case and described it adequately in commonly shared language: 'A Wassel 4 thumb but of the divergent convergent pattern, requiring tendon rebalancing and ostetotomies…' for a '1B', for example. Or that 'the two thumb duplicates are equal in size and therefore may need something like a Bilhaut-Cloquet procedure', for a '2A'.
我认为没有足够新的信息。目前展示的都是众所周知的,每个先天畸形的手外科医生看到每个病例的时候都会用共同的语言来描述:Wassel 4型拇指分叉特征的,需要肌腱转位和截骨,这是“1B”。或者:两个拇指在体积和大小上发育均等需要BC合并,这是'2A'。 感悟:审稿人的意见这样描述是没有异议的。其实我们的目的就是想把大家都知道的手术方式做一个总结,从这个来划定分型,但是需要改进的地方是我们一开始没有考虑到专业医师等级水准的事情。如果把专科医师等级水准、Wassel分型、新分型一起结合,应该是比较好的描述。比如报道一个拇指多指的患者治疗过程,我们可以描述为Wassel-IV型,新-I型,Level-II-III医师处理,这样我们就知道了具体的形态、手术方式以及医师的技术水准。
It is unsurprising, therefore, that the inter and intra reliability scores are so high. The system is used for classifying something obvious, that nobody can really get wrong. That was why the Wassel classification has been so popular because it is so easy to use. 因此,观察者之间和前后可靠性得分都很高,这不足为奇。该分型用于对显而易见的事物进行分类,所以没有人会出错。这就是Wassel分型之所以如此流行的原因,因为它易于使用。 感悟:此处想说明的意思就是这个意思,如果一个分型不能显而易见那肯定不够简单易懂,当然这里不能和审稿人抬杠,但是审稿人在这里的话正好说明了我们的分型不容易出错,不过的确需要有高等级的专业医师把控。
I am therefore somewhat hesitant to recommend publication of this system as a new classification that should be used by the international community, which is the idea behind every new system, that it be widely adopted and upheld as a foundation to group well-known conditions.
因此我犹豫推荐将此系统发表,在国际社会使用使用这个分型;每一个新的系统背后都有其深刻的思想,即广泛接收并支持它作为一个众所周知情况的基础。 感悟:我们分型背后的思想就是为Wassel分型做补充,为手术设计提供思路,为拇指多指治疗专科医师等级水准划分提供规则。
Is it accurate?准确性?
The methodologies are acceptable. The five surgeons were asked to classify the cases according to the morphologies, I think. There are no descriptions of their grades. It would have been more useful if they had a larger number of surgeons and of different grades, if they wanted to prove the point as listed in the Discussion, lines 152-159, that the system is useful for trainee surgeons.
该方法是可以接受的。我认为,五位外科医生被要求根据形态对病例进行分型,但没有关于其专业技术水平的描述。假如作者想证明“讨论”中第152-159行中列出的观点(该分型系统对培养训练专科医师有用),如果作者单位有大量的不同技术等级的外科医师会更好。 感悟:一开始有这样的想法去分高中低水准,但是后来因为时间的原因,比如有的医生工作忙没有参与,还有另外一个因素是没有查阅到汤教授的关于专科医师等级水准的文献,划分的科学性不够。两家医院不同级别的医师还是很多的,不知道这里的意思是不是这里如果详细记录和讨论一下训练培养的成长过程比较合适。 Furthermore, it was noted that the five surgeons noted down any questions they had but there was no mention of any subsequent discussions of their comments. I know if I was rating these, that I would have lots of comments which need to be addressed and brought out in the discussion. There are inevitably nuances that occur with any classification and these were simply bypassed in this paper. Even when rating a case using the Wassel classification, I would sometimes struggle between a type 3 or 4, based on the appearance of the bases of the proximal phalanges. A new classification system needs to discuss these things.
另外,五个医师对新的分型进行了讨论并有记录,但是作者在后面的讨论中没有进行分析。如果是我做了这些评分我会在讨论中大量的来分析这些意见。任何分型都不可避免的有一些差错,本文没有讨论这个。即使使用Wassel分型,根据近节指骨基底部的外观,我有时也会在3型或4型之间挣扎。一个新的分类系统需要讨论这些事情。 感悟:我们开始讨论的时候录制了视频会议录像,可惜后来没有把大家的意见加进去,这点在后期的文章中我们会改进。这个的确是我在写文稿的时候经验不足导致,把重要的东西忽视了,只是捡了自己觉得好看的好听的好写的写上了。忠言逆耳利于行,这点以后一定要记住做到。
Is it relevant?有无意义?
Do we need another classification system? Are the existing ones enough for general communication in the international community? There are already several (Wassel, Wood, Zuidam etc etc), which are adequate for communicating research ideas and compare outcomes. Every institution will have their own technique for a particular presentation.
I think the ' classification' is useful at a local level for communication between the surgeons of the institutions involved in this paper, but there is not enough new or groundbreaking information to promote this as a new international classification.
我们是否需要另一个分型系统?现有的分型是否在国际交流中已经足够?已经有几种(Wassel,Wood,Zuidam等),足以传达研究思路和比较预后。每个机构对于特点的疾病都会有自己的技术。我认为“分型”在地方一级对于本文所涉及的机构的外科医生之间的交流非常有用,但是没有足够的新信息或开创性的信息将其推广为新的国际分型。 感悟:我们提出这个分型也是从局部实施开始的,希望介绍我们的经验去各地,让大家了解到在中国的某个区域的医院在使用这种分型方法来指导和培训专科医师,同时结合Wassel等其他分型一起学习交流。有没有价值和推广到全世界,需要大家一起讨论和使用中去了解和探索。
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