Unglaub Frank, Demir Erhan, Von Reim Roland, Van Schoonhoven Jorg, Hahn Peter
Handsurgery, Vulpius Klinik, Bad Rappenau, Germany.
Microsurgery. 2006;26(8):552-6. doi: 10.1002/micr.20287.
The aim of this follow-up study was to evaluate the functional and subjective results after thumb replantation. Twenty-four patients with replantation of the thumb, performed during the period 1992-1997, were reexamined after 6.5 years (range, 4.2-9.1 years post-injury). In 10 cases the amputations were isolated, 14 amputations were combined with other injuries of the hand, 15 amputations resulted from crush/avulsion injuries, and 9 amputations were sharp. Range of motion, grip strength, cutaneous sensibility, and upper-extremity functioning using the DASH questionnaire were determined. A correlation analysis with important variables was performed. Average range-of-motion in the metacarpophalangeal joint was 44 degrees (+/-24.2) and in the interphalangeal joint was 12 degrees (+/-8.4). Grip-strength of the injured hand was 70% (+/-31.4) and pinch strength was 68% (+/-28.7) in comparison to the non-injured hand. DASH-scores correlated with grip-strength, pinch-strength, and cutaneous sensation but no correlation was found between DASH and the level of amputation. Functional results were independent of amputation levels and patient age. Although the results of cutaneous sensibility were only moderate, patients were able to use their thumb to perform work and daily living activities. The majority of patients had returned to their previous occupation.
这项随访研究的目的是评估拇指再植后的功能和主观结果。对1992年至1997年期间进行拇指再植的24例患者在受伤后6.5年（范围为4.2至9.1年）进行了复查。其中10例为单纯拇指离断，14例合并手部其他损伤，15例为挤压/撕脱伤，9例为锐器伤。测定了掌指关节活动度、握力、皮肤感觉以及使用DASH问卷评估的上肢功能。对重要变量进行了相关性分析。掌指关节平均活动度为44度（±24.2），指间关节为12度（±8.4）。与健侧手相比，伤手的握力为70%（±31.4），捏力为68%（±28.7）。DASH评分与握力、捏力和皮肤感觉相关，但未发现DASH与离断水平之间存在相关性。功能结果与离断水平和患者年龄无关。尽管皮肤感觉结果仅为中等，但患者能够使用拇指进行工作和日常生活活动。大多数患者已恢复原工作。
