Hattori Yasunori, Doi Kazuteru, Ikeda Keisuke, Estrella Emmanuel P
Department of Orthopedic Surgery, Ogori Daiichi General Hospital and Yamaguchi University School of Medicine, Ogori, Yamaguchi City, Japan.
J Hand Surg Am. 2006 May-Jun;31(5):811-8. doi: 10.1016/j.jhsa.2006.02.020.
To compare the functional outcome of successful microsurgical replantation versus amputation closure for single fingertip amputations.
Forty-six fingertip amputations in 46 patients (23 were replanted successfully, 23 had amputation closure) were included in this study. Thumb amputations were excluded. Grip strength and active range of motion of the proximal interphalangeal joint were evaluated. The patients were questioned about their symptoms of pain, paresthesia, and cold intolerance. The Disabilities of the Arm, Shoulder, and Hand questionnaire was given and the disability/symptom score was evaluated. Patients' satisfaction with the surgical result was assessed. Time spent in the hospital and time off from work were reviewed.
Active range of motion of the proximal interphalangeal joint was greater in the successful replantation group. Although the existence of paresthesia and cold intolerance were not statistically different between the 2 groups, pain in the affected fingers was more frequent in the amputation closure group. The average Disabilities of the Arm, Shoulder, and Hand score of the successful replantation group was statistically better. All patients in the successful replantation group were highly or fairly satisfied with the surgical results, whereas 14 patients in the amputation closure group were highly or fairly satisfied. The time spent in the hospital and the time off from work for the successful replantation group were longer.
Successful replantation of single fingertip amputations can result in minimal pain, better functional outcome, better appearance, and higher patient satisfaction. We recommend attempting fingertip replantation not only to obtain the best appearance but also to gain better functional outcome. If the patient requests the simple surgery and earlier return to work amputation closure is an accepted method despite the disadvantage of digital shortening and the risk for a painful stump.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level III.
比较单指尖断指成功显微再植与截肢闭合术的功能结局。
本研究纳入46例患者的46例指尖断指（其中23例再植成功，23例行截肢闭合术）。拇指断指被排除。评估握力和近端指间关节的主动活动范围。询问患者疼痛、感觉异常和冷不耐受的症状。发放手臂、肩部和手部功能障碍问卷并评估残疾/症状评分。评估患者对手术结果的满意度。回顾住院时间和误工时间。
成功再植组近端指间关节的主动活动范围更大。虽然两组之间感觉异常和冷不耐受的发生率无统计学差异，但截肢闭合组患指疼痛更常见。成功再植组的手臂、肩部和手部功能障碍平均评分在统计学上更好。成功再植组的所有患者对手术结果高度或相当满意，而截肢闭合组有14例患者高度或相当满意。成功再植组的住院时间和误工时间更长。
单指尖断指成功再植可使疼痛最小化、功能结局更好、外观更佳且患者满意度更高。我们建议尝试指尖再植不仅是为了获得最佳外观，也是为了获得更好的功能结局。如果患者要求进行简单手术并更早返回工作岗位，截肢闭合术是一种可接受的方法，尽管存在手指缩短的缺点和残端疼痛的风险。
研究类型/证据水平：治疗性研究，Ⅲ级。
